indonesia investing in nutrition and early years...

INDONESIA – INVESTING IN NUTRITION AND EARLY YEARS

(INEY)

PROGRAM-FOR-RESULTS (PforR)

P164686

ENVIRONMENTAL AND SOCIAL SYSTEMS ASSESSMENT REPORT

(ESSA)

FINAL DRAFT

APRIL 18, 2018

PREPARED BY THE WORLD BANK

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

ABBREVIATIONS AND GLOSSARY

TERM EXPANDED TERM/ DEFINITION

ADD Alokasi Dana Desa or Village Funds Allocation

ANC Ante Natal Care

APBD Anggaran Pendapatan, dan Belanja Daerah or Regional Government Budget

BAPPEDA Badan Perencanaan Pembangunan Daerah or Regional Development Planning Agency

BAPPENAS Badan Perencanaan Pembangunan Nasional or National Development Planning Agency

BCC Behavioural Change Communication

BLH Badan Lingkungan Hidup or Environmental Agency

BPD Badan Permusyawaratan Desa or Village Council

BPJS Badan Penyelenggara Jaminan Sosial or Social Security Agency

BPNT Bantuan Pangan Non Tunai or Non-Cash Food Assistance Program

BPOM Badan Pengawas Obat dan Makanan or National Agency for Drug and Food Control

BPPSPAM Badan Peningkatan Penyelenggaran Sistem Penyediaan Air Minum or Village-Level Water

Board Association

BUMN Badan Usaha Milik Negara or State-Owned Enterprises

Bupati District Head

CBO Community Based Organisation

CDD Community Driven Development

CHS Complaint Handling System

CLTS Community Led Total Sanitation

CPASR Convergence Program to Accelerate Stunting Reduction

DAK Dana Alokasi Khusus or Special Allocation Funds

Dana Desa Village Funds

DDG Deputy Director General

DFAT Australian Department of Foreign Affairs and Trade

DG Director General

DHO District Health Office

DLI Disbursement Linked Indicator

Dusun Hamlet/s

ECED Early Childhood Education and Development

EHS Environmental Health and Safety

ESSA Environmental and Social Systems Assessment

FGM/C Female Genital Mutilation/Cutting

Germas Gerakan Masyarakat or Community Action

GIIP Good International Industry Practice

GOI Government of Indonesia

GRM Grievance Redress Mechanism

GRS Grievance Redress System

GSC Generasi Sehat dan Cerdas or Healthy and Bright Generation

HCF Health Care Facilities

HDW Human Development Worker

HIV Human Immunodeficiency Virus

HRH Human Resources for Health

INEY Investing in Nutrition and Early Years

IPC Inter-Personal Communication

Jampersal Jaminan Persalinan or Maternity Health Insurance

Kadus Hamlet Heads

Komda PP KIPI Komite Daerah Pengkajian dan Penanggulangan Kejadian Ikutan Pasca Imunisasi

Komnas PP KIPI Komite Nasional Pengkajian dan Penanggulangan Kejadian Ikutan Pasca Imunisasi

MCC Millennium Challenge Corporation

MOEC Ministry of Education and Culture


MOEF Ministry of Environment and Forestry

MOF Ministry of Finance

MOH Ministry of Health

MOHA Ministry of Home Affairs

MPWH Ministry of Public Works and Housing

MOSA Ministry of Social Affairs

MOV Ministry of Villages

Musrenbangdes Village Development Planning Deliberation

Musrenbangdus Hamlet Development Planning Deliberation

NatStrat Stunting National Strategy to Accelerate Stunting Prevention

NCD Non-communicable Disease

NGO Non-governmental Organisation

Nusantara Sehat Healthy Indonesia Program

OOPE Out of Pocket Public Expenditure

P3MD Program Pembangunan dan Pemberdayaan Masyarakat or Community Development and

Empowerment Program

PAD Project Appraisal Document

PAMSIMAS Penyediaan Air Minum dan Sanitasi Berbasis Masyarakat or National Rural Water Supply

and Sanitation Project

PAUD Pendidikan Anak Usia Dini or Early Childhood Education

PCN Project Concept Note

PCU Program Coordinating Unit

PDO Project Development Objective

Perda Local Government Regulation

Perpres Presidential Regulation

PforR Program-for-Results

PHC Primary Health Care

PHO Provincial Health Office

PKH Program Keluarga Harapan or National Social Assistance Program

PMTC Prevention of Mother to Child Transmission

PMU Project Management Unit

PNC Post Natal Care

PNPM Program Nasional Pemberdayaan Masyarakat or National Empowerment Program

Polindes Pondok Bersalin Desa or Village Level Delivery Post

Poskesdes Pos Kesehatan Desa or Village Health Post

Posyandu Integrated Health Service Post

PPJK Pusat Pembiayaan dan Jaminan Kesehatan or Center for Financing and Health Insurance

PSC Program Steering Committee

Puskesmas Public Primary Health Center

Pustu Auxiliary Puskesmas

RA Results Area

RCA Reality Check Approach

Rembuk A Gathering

RKPD Rencana Pembangunan Tahunan Daerah or Regional Annual Development Plan

RPJMN Rencana Pembangunan Jangka Menengah Nasional or National Medium-Term Development

Plan

SOP Standard Operating Procedure

SOVP Secretariat of the Vice President

SUN Scaling Up Nutrition

TBA Traditional Birth Attendant

Tim Pemantau Supervision Team

Tim Pembina Facilitation Team


TNP2K Tim Nasional Percepatan Penanggulangan Kemiskinan or The National Team for Poverty

Reduction

ToT Training of Trainers

UDB Unified Data Base

UHC Universal Health Coverage

UNICEF United Nations Fund for Children

Wali Kota Mayor

WASH Water, Sanitation, and Hygiene

WB World Bank

WBG World Bank Group

WHO World Health Organization

Indonesia – Investing in Nutrition and Early Years (INEY) Page | iv

TABLE OF CONTENTS

EXECUTIVE SUMMARY ........................................................................................................................................ vi

A INTRODUCTION ................................................................................................................................................ 1

A.1 OBJECTIVES .................................................................................................................................................... 1 A.2 APPROACH TO THE ESSA................................................................................................................................ 1

B PROGRAM DESCRIPTION .............................................................................................................................. 4

B.1 GOVERNMENT PROGRAM ................................................................................................................................ 4 B.2 INVESTING IN NUTRITION AND EARLY YEARS (INEY) PROGRAM FOR RESULTS (PFORR) .............................. 4 B.3 SOCIAL AND ENVIRONMENTAL RISKS AND BENEFITS ..................................................................................... 6

C STAKEHOLDER ENGAGEMENT ................................................................................................................... 9

D POLICY, REGULATORY AND INSTITUTIONAL FRAMEWORKS ...................................................... 10

D.1 POLICY, LEGAL, AND REGULATORY FRAMEWORKS ...................................................................................... 10 D.1.1 Environment ......................................................................................................................................... 10 D.1.2 Social .......................................................................................................................................................... 12

D.2 INSTITUTIONAL RESPONSIBILITIES ................................................................................................................ 15 D.2.1 Environment ......................................................................................................................................... 15 D.2.2 Social .................................................................................................................................................... 16

E EXPERIENCE FROM PREVIOUS PROJECTS ........................................................................................... 18

F CAPACITY AND PERFORMANCE ASSESSMENT ................................................................................... 20

F.1 ENVIRONMENTAL CONSIDERATIONS ............................................................................................................. 20 F.2 SOCIAL CONSIDERATIONS ............................................................................................................................. 21

F.2.1 Role of Village Government, Posyandu, PAUD and Community Participation ................................... 22 F.2.2 Inclusion and Behaviour Change ......................................................................................................... 25 F.2.3 Complaints and Feedback Handling .................................................................................................... 28 F.2.4 Informed Decision Making and Consent .............................................................................................. 30

G ENVIRONMENTAL AND SOCIAL ACTIONS. ........................................................................................... 31

G.1 ENVIRONMENTAL MEASURES ....................................................................................................................... 31 G.2 SOCIAL MEASURES ....................................................................................................................................... 32

H ENVIRONMENTAL AND SOCIAL RISK RATING .................................................................................... 35

I INPUTS TO THE PROGRAM IMPLEMENTATION SUPPORT PLAN ................................................... 36

I.1 ENVIRONMENT .............................................................................................................................................. 36 I.2 SOCIAL .......................................................................................................................................................... 36

J BIBLIOGRAPHY .............................................................................................................................................. 38

Indonesia – Investing in Nutrition and Early Years (INEY) Page | v

LIST OF ANNEXES

Annex 1: Program Results Framework .................................................................................................................. 42 Annex 2: Environmental and Social Risks and Impacts Screening ........................................................................ 45 Annex 3: Stakeholder Engagement ........................................................................................................................ 49 Annex 4: Analysis Against Key Policy Elements of Bank Policy Program-for-Results Financing ....................... 77 Annex 5: Capacity Assessment in Managing Environmental Related Issues and Risks for INEY-PforR ............. 87 Annex 6: Social considerations of nutrition-specific and nutrition-sensitive interventions. .................................. 94

LIST OF TABLES

Table 1: Summary of Key Risks for the Five Priority Packages .............................................................................. 7 Table 2: Policies, Regulations and Guidelines Related to Environmental Risk ..................................................... 10 Table 3: Key Institutional Stakeholders for the Program. ...................................................................................... 15 Table 4: Institutional Roles and Responsibilities for Environmental Performance. ............................................... 15 Table 5: Share of Health and Education-related Activities in APBDes in the District of Talaud. ......................... 22 Table 6: Environmental Measures to Strengthen Institutional Capacity ................................................................ 31 Table 7: Environmental Measures to Generate the Desired Environmental Effects .............................................. 32 Table 8: Proposed Environmental and Social Actions. .......................................................................................... 34 Table 9: Stakeholders consulted in the preparation of the INEY Program. ........................................................... 49

Indonesia – Investing in Nutrition and Early Years (INEY) Page | vi

EXECUTIVE SUMMARY

1. This Environmental and Social Systems Assessment (ESSA) report has been prepared for the World

Bank's Investing in Nutrition and Early Years (INEY) to be financed under a Program-for-Results operation

(PforR). The ESSA process examines the environmental and social management systems that are applicable

to the INEY PforR to assess their compliance with the Bank Policy on PforR Financing. It aims to ensure

that the program’s environmental and social risks will be managed adequately and that it complies with the

basic principles of sustainable development. The scope of the ESSA process includes an assessment of:

a. potential environmental and social risks and benefits;

b. environmental and social systems that apply to the program;

c. implementation experience and capacity;

d. whether system and performance are consistent with key principles of the Bank Policy; and

e. steps required to improve scope of system or capacity.

2. The preparation of this ESSA report is based on a desktop information review, field visits and

consultations undertaken at the central and subnational level. Engagement has taken place with government

(national, district and villages); development partners; service providers; civil society organisations; private

sectors; and affected and beneficiary communities or their representatives. A consultation workshop on the

draft ESSA was undertaken on April 09, 2018 with stakeholder representing five districts and national level

government. The draft ESSA report circulated prior to the meeting and a summary in Bahasa was also

shared.

3. The proposed Program Development Objective (PDO) of the INEY PforR is to increase simultaneous

utilisation of nutrition interventions by 1,000-day households in priority districts. The term “1,000-day

households” refers to households with pregnant women and/or children aged 0-24 months.

4. The PforR Program will support a subset of interventions of the government’s Convergence Program

to Accelerate Stunting Reduction (“the Convergence Program” or CPASR) as well as the convergence of

instruments that are critical to coordinating the delivery of all priority nutrition-specific and nutrition-

sensitive interventions in the priority locations. The overall objective of the Convergence Program is to

accelerate stunting reduction within the existing regulatory and institutional framework. The Convergence

Program will support achievement of the National Medium-Term Development Plans’ (RPJMN) target to

reduce the prevalence of stunting from the current prevalence of 37.2% down to 28% by 2019. The

Convergence Program will also support achievement of the Scaling Up Nutrition (SUN) Movement 2025

targets.

5. The PforR Program does not have a single system related to environment and social performance. As

such, the assessment focused on key systems that impact on the health, particularly sexual and reproductive

health of women and girls, water, sanitation and hygiene (WASH), and education service delivery at the

household and village level, including the relevant provisions and systems that underpin the Village Law.

Similarly, the environment assessment focused on reviewing the adequacy and implementation of relevant

national policy, regulations and guidelines related to handling, distribution and storage of supplements and

vaccines as well as the safe handling of medical waste (at the primary health care facility).

6. Overall, the risk assessment and screening suggests that the environmental impact of the program is

likely to be positive; helping to ensure women and children have access to, and make use of, improved

drinking water supply, better sanitation facilities and sanitation conditions.1 Main environmental issues and

risks are expected to be moderate and relate to safe handling of pharmaceutical waste and disposal systems

managed by Posyandu (Integrated Service Health Post) and Puskesmas (Public Primary Health Center),

1 The INEY PforR will support the coordination of WASH programs at MPWH and the uptake and utilization of water and sanitation facilities, but

it will not finance the infrastructure itself.

Indonesia – Investing in Nutrition and Early Years (INEY) Page | vii

quality and quantity (continuity) aspects of water supply provision and unsafe construction practices for

sanitation facilities. Measures to strengthen system performance for environmental management are: (i)

strengthening the relevant institutions to understand and manage pharmaceutical waste including; (ii)

watershed management to ensure target beneficiaries have sustainable access to water and sanitation

facilities and finally; (iii) promoting hygiene practices.

7. Social effects are likely to arise from the activities associated with Results Area (RA) 4, (Convergence

of village service delivery), RA 2 (Strengthen delivery of sector programs) and RA 3 (Strengthen

convergence of district activities). The ESSA considered social effects relating to the ability of individuals,

households and groups to obtain services in an accessible, safe, and inclusive manner. It also considered

whether educational, behavioural change communication, information on nutrition specific interventions,

particularly health services, are delivered in a way that takes into consideration local context including

literacy, language, and cultural aspects of the beneficiaries. This includes ensuring informed consent and

making available a process for raising complaints and concerns. Potential for inequality and conflict will

stem from real or perceived differences in how the benefits of the program are distributed which makes the

need for an effective grievance system important. If village level systems are inclusive and participatory

and managed well the most vulnerable stand to benefit. In this light, it is expected that Indigenous Peoples,

if present in the targeted communities, should benefit from the program and vulnerable groups and

Indigenous Peoples should not be adversely impacted. Poorer families, lesser educated mothers, young

mothers, older mothers, unmarried mothers, single parent families or child headed households, and parents

with HIV status are likely to be the most vulnerable. Based on the above assessment, the Program is expected

to contribute to addressing equity issues and therefore the risk has been rated as low.

8. The INEY PforR is not currently planning to support infrastructure investments. The infrastructure

activities related to Water, Sanitation and Hygiene (WASH) are funded through the National Rural Water

Supply and Sanitation Project (PAMSIMAS). There are no anticipated adverse impacts to natural habitats,

physical cultural property, natural resources, or to assets or livelihoods of people based on the activities

supported by the INEY PforR. System assessments with regards to environmental and social risk and impact

management emerging from land acquisition, land conversion and infrastructure activities are therefore not

within the scope of this ESSA.

9. Communities and individuals who believe that they are adversely affected as a result of a Bank

supported PforR operation, as defined by the applicable policy and procedures, may submit complaints to

the existing program grievance redress mechanism or the WB’s Grievance Redress Service (GRS). The

GRS ensures that complaints received are promptly reviewed in order to address pertinent concerns.

Affected communities and individuals may submit their complaint to the WB’s independent Inspection

Panel which determines whether harm occurred, or could occur, as a result of WB non-compliance with its

policies and procedures. Complaints may be submitted at any time after concerns have been brought directly

to the World Bank's attention, and Bank Management has been given an opportunity to respond. For

information on how to submit complaints to the World Bank’s corporate Grievance Redress Service (GRS),

please visit http://www.worldbank.org/GRS. For information on how to submit complaints to the World

Bank Inspection Panel, please visit www.inspectionpanel.org.

Indonesia – Investing in Nutrition and Early Years (INEY) Page | 1

A INTRODUCTION

A.1 Objectives

10. The ESSA process is guided by the key policy elements as established by the Bank Policy PforR

Financing (December 2017) and as they apply to the assessment of the Government of Indonesia (GOI)

systems and the relevant agencies’ capacity to plan and implement effective measures for managing

environmental and social risks and impacts. The key policy elements with regards to environmental and

social management systems of the Bank Policy are:

a. promote environmental and social sustainability in the PforR Program design; avoid, minimize or

mitigate adverse impacts, and promote informed decision-making relating to the PforR Program’s

environmental and social impacts;

b. avoid, minimize or mitigate adverse impacts on natural habitats and physical cultural resources resulting

from the PforR Program;

c. protect public and worker safety against the potential risks associated with: (i) construction and/or

operations of facilities or other operational practices under the PforR Program; (ii) exposure to toxic

chemicals, hazardous waste, and other dangerous materials under the PforR Program; and (iii)

reconstruction or rehabilitation of infrastructure located in areas prone to natural hazards;

d. manage land acquisition and loss of access to natural resources in a way that avoids or minimizes

displacement, and assist the affected people in improving, or at the minimum restoring, their livelihoods

and living standards;

e. give due consideration to the cultural appropriateness of, and equitable access to, PforR Program

benefits, giving special attention to the rights and interests of the Indigenous Peoples and to the needs

or concerns of vulnerable groups; and

f. avoid exacerbating social conflict, especially in fragile states, post-conflict areas, or areas subject to

territorial disputes.

11. The objectives of the ESSA are to assess:

a. potential environmental and social risks and benefits;

b. environmental and social systems that apply to the program;

c. implementation experience and capacity;

d. whether system and performance are consistent with the key principles of the Bank Policy; and

e. steps to be taken to improve the scope of system or capacity.

A.2 Approach to the ESSA

12. The ESSA process focused on the systems to address the following effects identified through screening:

a. Environmental considerations: supply, distribution, and storage of vitamins/supplements. Particular

issues on disposal of expired vitamins, and storage of oversupplied vitamins; supply, distribution, and

storage of vaccines, and disposal of pharmaceutical waste (expired/damaged/unused vaccines, vaccine

vials, used syringes); access to improved drinking water (quality and quantity), including water

testing/sampling, safe distance from water pollution sources, watershed management, water collection

and distribution; and, access to improved sanitation facilities, including safe distance from water

pollution sources, and provisions of water supply to toilets.

b. Social considerations: lack of participation by women, young women, and vulnerable groups in village

level decision making; challenged to program benefits for remote communities and Indigenous Peoples;

limited decision-making power and access to and control over resources at the household level by

mothers; education, water and sanitation and health service delivery not accessible, inclusive nor context

specific (i.e. do not take into account literacy, including health literacy, language, gender, and cultural

aspects); behavioural change communication not context specific and only aimed at mothers or pregnant


women; distribution of services not based on needs; poorly functioning systems for raising and

addressing complaints and concerns; and poorly applied informed consent processes.

13. Review of the Environmental and Social systems relevant to the Program. The assessment focuses

on the adequacy of the relevant systems, including implementation and the GOI’s capacity to enforce. The

system review is approached in two parts:

a. Identification of relevant systems that are pertinent to the ESSA will be addressed in Section D on

Review of Policy, Regulatory, and Institutional Frameworks; and

b. Analysis on the implementation of the systems, including capacity and enforcement of certain

environmental and social measures, will be addressed in Section F.

14. The ESSA was informed by a review of relevant information on the environmental and social systems

underpinning the program, as well as engagement and field visits to understand the operationalization of

those systems, including the infrastructure in place to support and the capacity to implement them. The

ESSA process thus far has included:

a. Information review of relevant environmental and social management procedures, standards

institutional responsibilities that will apply to the INEY PforR:

• Social: National guidelines on PAUD (Early Childhood Education, ECED), Posyandu (i.e. outreach,

facilitation, community engagement), administration of vaccines (i.e. consent, safe handling,

counselling), village laws and guiding regulations (e.g. community participation, use of village

funds, access to information). National instruments with provisions for Indigenous Peoples were

also reviewed. Understanding implementation of previous projects such as Healthy and Bright

Generation (GSC), National Community Empowerment Program (PNPM), PAMSIMAS was also

used to inform system capacity under the ESSA.

• Environment: National guidelines issued by Ministry of Health (MOH) on handling, distribution

and storage of supplements (roles, responsibilities and oversight); Minister of Health Regulation

(PMK No. 12/2017) regarding the implementation of immunizations which include provisions for

the supply, distribution and storage of vaccines; procedures for handling and disposal of medical

waste including: used syringes, expired/damaged/unused vaccines, and empty vaccine vial (Minister

of Environment and Forestry (MOEF) Regulation no 56 year 2015 on procedure and technical

requirement for management of hazardous waste from health service facility); MOH Regulation no

27 year 2017 on Guidelines for prevention and control infection in health service facility; Posyandu

management system overall (including manuals for midwives and cadres with regards to community

engagement, consent, and grievance handling, or the lack thereof); existing technical

guidelines/code of practice for the construction of community level water supply facilities

(developed through PAMSIMAS and PNPM Rural); and Provisions of the program/subject within

the existing PAUD curriculum and PAUD manuals.

b. Field assessments:

• Social: Site-visits were conducted to the Island District of Talaud, South Sulawesi (13-17

November, 2017) and Ketapang District of West Kalimantan (12-15 February, 2018) to conduct a

preliminary environmental and social systems assessment for INEY PforR. The Talaud mission was

jointly-organized with GSC team from the Ministry of Villages (MOV). The safeguards team visited

5 Sub-Districts in total, 3 in the larger Karakelong Island (Beo, Rainis and Esang Selatan) and 2 in

the smaller Kabaruan Island (Kabaruan and Damau). In Karakelong, the team visited 3 villages,

Desa Bantik in Beo, Desa Ensem in Essang Selatan and Desa Rainis in Rainis. In Kabaruan, the

team visited 2 villages, Desa Damau Bawone in Damau and Desa Pangeran in Kabaruan. During

the Ketapang mission the safeguards team visited 2 Sub-Districts (Delta Pawan and Muara Pawan)

in total, and 3 villages. In Delta Pawan, the team visited Desa SukaBangun and in Muara Pawan,

Desa SukaMaju and Desa Ulak Medang.


• Environment: A site visit to Cianjur District was conducted on 8-9 February 2018 and included a

visit to the Environmental Sanitation unit of District Health Office in Cianjur District, a Puskesmas

in Cikalong, and a Posyandu in Desa Kamurang to gather information related to Puskesmas and

Posyandu operations/activities related to stunting prevention and medical waste handling. A visit to

the Environmental Agency at Cianjur District was also conducted to collect information relating to

the implementation of regulatory provisions on medical waste management.

15. Consultations for the Project including for the ESSA included:

• Social: Consultations at the community level, with relevant district agencies, and with ministries at

the central level, including Ministry of Education and Culture (MOEC), and MOH.

• Environment: Consultations at district level with relevant district agencies (BLH and Dinkes); in

sub-districts and villages (Puskesmas and Posyandu); and in national/central level including MOH,

MOEF and MOEC.

16. A consultation workshop on the draft ESSA was undertaken on April 09, 2018 with representatives

from central ministries, including MOHA, MOEF, MPWH, MOH as well as representatives from Central

Maluku District, Gorontalo District of Gorontalo Province, Cianjur District of West-Java, Central Lombok

District of NTB and Ketapang District of West Kalimantan. The draft ESSA report was circulated prior to

the meeting and a summary in Bahasa was also shared. Observations from the workshop have been

incorporated into the ESSA report and a complete list of participants and a summary of their comments is

included in Annex 3. The final draft of the ESSA report will be disclosed publicly through the World Bank

external website and public comments will be solicited during a period defined and reserved for comments.


B PROGRAM DESCRIPTION

B.1 Government Program

17. The overall objective of the Convergence Program to Accelerate Stunting Reduction (“the Convergence

Program” or CPASR) is to accelerate stunting reduction within the existing regulatory and institutional

framework. The overall objective of the Convergence Program to Accelerate Stunting Reduction is to

accelerate stunting reduction within the existing regulatory and institutional framework. This objective will

be achieved by:

a. Ensuring stunting reduction is a priority for all leaders at all levels of government and society, from the

President to Village Heads;

b. Increase public awareness of stunting, its impacts and causes as well as its solutions;

c. Expand the coverage and improve the quality of programs that deliver priority nutrition-specific and

nutrition-sensitive interventions;

d. Improve access to nutritious food; and

e. Encourage monitoring, evaluation and learning.

18. The Convergence Program will support achievement of the National Medium-Term Development

Plans’ (RPJMN) target to reduce the prevalence of stunting from the current prevalence of 37.2% down to

28% by 2019.The Convergence Program will also support achievement of the SUN Movement 2025 targets.

B.2 Investing in Nutrition and Early Years (INEY) Program for Results (PforR)

19. The proposed PDO of the INEY PforR is to increase simultaneous utilization of nutrition interventions

by 1,000-Day Households in Priority Districts.

20. The PforR Program will support a subset of interventions of the government’s Convergence Program

as well as the convergence of instruments that are critical to coordinating the delivery of all priority nutrition-

specific and nutrition-sensitive interventions in the priority locations. Building on the experience of Peru

and other multi-sectoral efforts to reduce stunting, the government’s National Strategy to Accelerate

Stunting Prevention (NatStrat Stunting) acknowledges both the need to improve the delivery of individual

priority sector interventions as well as the planning, budgeting, monitoring, evaluation and citizen

engagement systems that can drive coordination, public participation, accountability and performance across

all interventions. The government has requested that the PforR Program support both aspects of the

Government Program.

21. The PforR Program will focus on four Result Areas (RAs):

a. Results Area 1: Strengthen national leadership. This RA will support activities that are critical to

securing the commitments of subnational leaders (Bupati and Wali Kota) to converge district programs

and activities, improving expenditure systems for monitoring and assessing the performance of national

spending on nutrition interventions, and ensuring stunting remains politically salient and accelerating

learning on what works and what doesn’t. Key activities include Annual Stunting Summits

(SOVP/TNP2K), National Expenditure Tagging and Performance Reviews (BAPPENAS & MOF), and

implementation of an annual mini-anthropometric module in SUSENAS (BPS).

b. Results Area 2: Strengthen delivery of sector programs. RA 2 will support improvements to activities

that will increase the capacity of ECED teachers to deliver nutrition-sensitive services to parents and 0-

2-year-old children, enhance the nutrition-sensitivity and implementation quality of the BPNT (Non-

Cash Food Assistance Program), and increase capacity of districts to design and Puskesmas to deliver

locally-adapted IPC (interpersonal communication) activities. Key Activities include implementation of

the ECED teacher professional development program with nutrition-sensitive modules (MOEC),


implementation of the nutrition-sensitive BPNT (MOSA) and implementation of the Interpersonal

Communication (IPC) capacity development for districts (MOH).

c. Results Area 3: Strengthen convergence of district activities. This RA will support activities that will

strengthen evidence- and results-based budgeting at the district-level, incentivize districts to spend more

on nutrition interventions and monitoring systems (including behavioural change programming), and

improve alignment of district and village plans and budgets. The main activity is implementation of an

annual performance assessment to measure districts’ implementation of the convergence program,

incentivized by a Programmatic DAK for Stunting Convergence (BAPPENAS and MOF), which together

will support districts to implement district-level Convergence Actions including local stunting

surveillance, local Behaviour Change Communication (BCC) activities, and mobilization of Human

Development Workers (HDWs).

d. Results Area 4: Village delivery convergence. This RA will support activities that will converge delivery

of priority interventions on all 1,000-day households in villages, incentivize villages to allocate more

Dana Desa (DD) to priority nutrition-specific and nutrition-sensitive interventions, and increase

participation in community-based growth promotion activities. Key Activities include village-level

Social Mapping of 1,000-day households, Village Convergence Scorecards and Height-based

Community Growth Promotion (MOV, MOH and MOF). The RA will benefit from the HDW activates

financed under the Programmatic DAK for Stunting Convergence (RA 3).

22. The Convergence Program identified 100 priority districts of high stunting prevalence and incidence

for 2018, and proposes an ambitious scale up for 2019 and beyond. The priority locations were selected by

overlaying MOH’s data with areas of high stunting prevalence, in addition to MOSA and TNP2K data on

poverty.2 In 2018 it includes districts in all 34 provinces, in which there is at least one district in each

province, and which covers 1,891 sub-districts, 21,888 villages and approximately 3.1 million stunted

children. Full national coverage is expected in 2021. The term “priority districts” refers to those with highest

prevalence and incidence of stunting as identified in the NatStrat Stunting.

Figure 1: Priority Locations (2018-2019).

Source: NatStrat Stunting Document, TNP2K, 2017

2 Potential priority districts were highlighted and visited to verify the data. The team who was led by the Kemenko PMK carried out mapping of the

areas to flag the high stunting prevalence villages. Teams also advocated for the importance of stunting reduction on their mission, to ensure the

commitment and support of provinces and district governments.


23. The institutional arrangements, as shown in the diagram below, consist of a steering committee,

executing agency, enabling agencies, implementing agencies and district and village level governments.

Figure 2: Proposed INEY PforR Institutional Arrangements

B.3 Social and Environmental Risks and Benefits

24. The environmental and social screening assessment (Annex 2) indicated that potential social and

environmental risks and impacts associated with the activities supported by the PforR are moderate, with

environmental risks, in particular, requiring further measures.

25. The screening exercise of the five priority packages indicated that key environmental risks mainly relate

to safe-handling of pharmaceutical waste and disposal systems managed by Posyandu and Puskesmas,

quantity and quality aspects of water supply provision and unsafe construction practices for sanitation

facilities.


Table 1: Summary of Key Risks for the Five Priority Packages

Five Priority Service Packages Potential Environmental and Social Issues and Risks

1.b. Taking iron tablets during

pregnancy

Environment: Public health issues relate to supply, distribution and storage

of vitamins/supplements. Particular issues relate to the disposal of expired

vitamins, and storage of oversupplied vitamins.

1.a. Four prenatal care visits

for pregnant women

1.b. Taking iron tablets during

pregnancy

1.c. Growth monitoring

1.d. Three postnatal care visits

Social: Access to services (to be framed within the overall access to

healthcare), information, and consent needs to be sensitive to social, religious,

cultural and other beliefs and values.

1.e. Complete childhood

immunizations

Environment: Supply, distribution and storage of vaccines; and disposal of

pharmaceutical waste (expired/damaged/unused vaccines, vaccine vials, used

syringes).

Social: Access to immunization services (to be framed within the overall

access to health services), consent and access to information need to be

sensitive to social, religious, cultural and other beliefs and values.

2. Nutrition, Hygiene and

Parent Counselling (including

2.a and 2.b)

Social: Access to counselling, cultural appropriateness of counselling delivery

and social acceptability, community engagement.

3.a. Access to improved

drinking water

Environment: Access to improved drinking water: Quality and quantity

(continuity) of water supply provision, weak implementation of water quality

control, weak construction supervision of the implementation of the technical

guidelines for the construction of community level water supply facilities.

Social: Access to water for all and includes participation of girls, women and

vulnerable groups in provisioning.

3.b. Access to improved

sanitation facility

Environment: Access to improved sanitation facility: Improper design

practices on sanitation facilities including non-compliance with the safe

distance requirements and the lack of provisions for water supply to toilets.

Social: Needs to take into account the needs of girls and women. Since the

model adopted is Community Led Total Sanitation (CLTS) risks are low.

Facilitation skills could be an important determinant for social outcomes.

5. a. Participation in PAUD for

early learning/stimulation

Environment: Hand-washing program will benefit the early years learning

towards improved personal hygiene for school children.

Social: Access to PAUD services for all, including poor and vulnerable

families previously supported by GSC, appropriateness of service delivery.

5.b. Introducing Parenting

Education through PAUD

teachers

Social: Access to marginalized and vulnerable groups that do not reside in a

village/and mothers and fathers that do not place their children in TK/PAUD.

Men should also be involved. Potential for reaching out to adolescent girls and

boys should be explored.

26. The program activities are not expected to have a significant adverse environmental footprint, but will

provide an opportunity to enhance systems related to ensuring safe, clean and sustainable public health

provisions. Overall, the risk assessment and screening suggests that the environmental impact of the program

is likely to be positive. The program is expected to deliver a number of environmental benefits, such as

access to improved drinking water supply, access to better sanitation facilities and improved sanitation

conditions. This may reduce the disease burden associated with these factors and improve the quality of life.

27. Main environmental issues and risks are expected to be moderate and will relate to safe handling of

pharmaceutical waste and disposal systems managed by Posyandu and Puskesmas, quality and quantity

(continuity) aspects of water supply provision and sanitation. Potential environmental risks are identified as

follows: (i) disposal of expired vitamins and storage of oversupplied vitamins; (ii) supply, distribution and

storage of vaccines as well as disposal of pharmaceutical waste (expired/damaged/unused vaccines, vaccine


vials and used syringes); (iii) quality and quantity (continuity) aspects of water supply provision and

sanitation.

28. The activities of the INEY PforR are intended to improve outcomes for families of 1,000-day

households in priority districts through converging delivery of priority nutrition-specific and nutrition-

sensitive interventions. The overall effect of the investments is socially beneficial. Social effects assessed

for the ESSA mainly relate to Result Area 4; prioritizing convergence of village service delivery.

29. At the household and community level the program specifically targets children and their caregivers,

who are likely to be their mothers. Women and girls tend to predominately carry the burden for childcare.

Further, their status may limit their access to and control over resources (direct or indirect); which means

less decision-making power in the household and at the village level; impacting their ability to access

services and their own health and that of their children. These constraints to access to resources, voice and

agency impact on children’s survival, health and nutrition. For the program to be effective these

considerations need to be reflected in the delivery of activities. The interventions will also need to consider

how men can be involved at the household and village level in terms of knowledge, attitudes, and practice

to enable them to positively impact on nutrition and stunting.

30. The delivery of services for nutrition specific and nutrition sensitive interventions is focussed on

outreach, education, BCC, immunization, home visits, and provision of supplements. To some degree, these

are reliant on household and village level decision-making, which may benefit some and exclude others.

There could be potential for complaints and conflict if there are disparities or perceptions that some benefit

more than others and it is not based on needs. There is also potential for elite capture.

31. The INEY PforR is not currently planning to support infrastructure investments. The infrastructure

activities related to WASH are funded through PAMSIMAS and are therefore are not within the INEY PforR

boundaries. There are no anticipated adverse impacts to natural habitats, physical cultural property, natural

resources, or to assets or livelihoods of people based on the activities supported by the INEY PforR. System

assessments with regards to environmental and social risk and impact management emerging from land

acquisition, land conversion and infrastructure activities are therefore not within the scope of this ESSA.


C STAKEHOLDER ENGAGEMENT

32. This section provides a summary of the engagement activities undertaken for the INEY PforR and

specifically for the ESSA as well as future engagement activities for the disclosure of the ESSA.

33. Stakeholder groups consulted with and details of consultations are provided in Annex 3.

a. Potentially affected and beneficiary communities or their representatives: 36 villages across 8

districts.

b. Village Governments: Village Heads, Posyandu cadres, PAUD teachers, Village Level Water Board

Associations (BPPSPAM) cadres, community leaders and religious figures from 36 villages across 8

districts.

c. District Governments: Bupatis, district planning departments (BAPPEDA), district financial

management offices (DPKD), district sector departments (Health, Public Works, Education, Social

Affairs, Environment and Village Development and Community Empowerment) in eight districts from

seven provinces between November 2017 and February 2018. It also included consultations with Camat

(sub-district heads), Puskesmas heads and technical staff in 18 sub-districts.

d. Central Government Agencies: Echelon I, II and III as well as technical staff from the SOVP,

BAPPENAS, MOF, MOH, MOEC, MPWH, MOSA, MOHA, MOEF, and MOV.

e. Civil Society Organisations: SUN Movement3 Secretariat, Nutrition International, University of

Indonesia, Survey Meter, and Tanoto Foundation as part of the preparation process.

f. Development Partners: DFAT, UNICEF and MCC/MCA-I, Towards a Strong and Prosperous

Indonesia (MAHKOTA), Indonesia Governance for Growth (KOMPAK), and Empowering Indonesian

Women for Poverty Reduction (MAMPU).

g. Private Sector: Engagement with the private sector was more limited given the nature of the

Convergence Program, and included only Indofood4 and the SUN Business Network.

34. Engagement methods included one-to-one meetings, formal presentations, Rembuk, focus group

discussions and the sharing of project documentation. A consultation workshop on the draft ESSA was

undertaken on April 09, 2018 with representatives from central ministries, including MOHA, MOEF, MOH

as well as representatives from Central Maluku District, Gorontalo District, Cianjur District of West-Java,

Central Lombok District of NTB and Ketapang District of West Kalimantan. The draft ESSA report was

circulated prior to the meeting and a summary in Bahasa was also shared. Observations from the workshop

have been incorporated into the ESSA report and a complete list of participants and a summary of their

comments are also included in Annex 3. The final draft of the ESSA report will be disclosed publicly through

the World Bank external website and public comments will be solicited during a period defined and reserved

for comments. Grievance redress is discussed as part of the systems assessment and proposed actions.

35. Poorer families, lesser educated mothers, young mothers, older mothers, unmarried mothers, single

parent families or child headed households, and parents with HIV status are likely to be the most vulnerable.

However, they are not expected to be adversely impacted as a result of the INEY PforR. Indigenous Peoples

who may have specific needs will need to be consulted meaningfully to ensure their participation. The HDW

and social mapping will be key to ensure the needs of the groups mentioned are captured in the planning

and implementation of the desired interventions and that no barriers exist to their participation. The HDW

training will also include materials that emphasise women’s empowerment, men’s participation in parenting

as well as risk of early marriage and adolescent pregnancy and hygiene best practice.

3 The Government’s commitment and initiatives to reduce stunting are a part of the Global SUN Movement which was launched in 2010, with a

basic principle that all citizens have the right to gain access to sufficient and nutritious food. Indonesia joined the movement in 2011 upon delivery

of a letter of participation by the Minister of Health (MoH) to the United Nations Secretary-General. The movement is now endorsed by 57

developing countries, including Indonesia, and over a hundred partners and nearly 3000 community service organizations.

4 Indofood is a major Indonesian company involved in the food industry.


D POLICY, REGULATORY AND INSTITUTIONAL FRAMEWORKS

D.1 Policy, Legal, and Regulatory Frameworks

D.1.1 Environment

36. Environmental management for INEY program aims to strengthen capacities needed to manage

environmental risks associated with the Program; and provide support to the Program to help achieve its

desired results sustainably. Within this context, the ESSA assessed whether the management system

mitigates impacts, provides transparency and accountability, and generally performs effectively in

identifying and addressing environmental risks. The table below describes policies, regulations and

guidelines related to provisions in managing the potential environmental issues and risks:

Table 2: Policies, Regulations and Guidelines Related to Environmental Risk

Potential Environmental Issues and

Risks Policies, Regulations and Guidelines

Program’s Priority Services: Maternal and Child Health Services

1. Supply, distribution, and storage of

vitamins/supplements. Particular issue

related to the disposal of expired

vitamins, and storage of oversupplied

vitamins.

The MOH Guidelines (2016) regarding: The Integrated

Management for Vitamin A Supplement.

Provisions: Planning, supply, storage and distribution of Vitamin A.

(a). Planning: Number of supplies is calculated and prepared based

on data derived from the district health offices of the MOH. This

process aims to avoid either under-supply or over-supply of

vitamins. Data for targeted beneficiaries were taken from the Health

Development Program (Program Pembangunan Kesehatan).

(b) Supply: Vitamins are supplied by Directorate General of Public

Pharmaceutical and Health Supplies (Direktorat Tata Kelola Obat

Publik dan Perbekalan Kesehatan) through a pharmaceutical facility

at the district level. At the same time, buffer stocks are kept at the

provincial level of the pharmaceutical facility.

(c) Storage and Distribution: Vitamins are kept safely at the

pharmaceutical facility according to procedure regulated by MOH.

Distribution is handled by pharmaceutical facility at the district level

to Posyandu through Puskesmas.

2. Supply, distribution, and storage of

vaccines, and disposal of

pharmaceutical waste

(expired/damaged/unused vaccines,

vaccine vials, used syringes).

MOH Regulation No. 12 Year 2017 on The Implementation of

Immunizations.

Provisions: Planning, supply and distribution, storage and

maintenance, waste disposal, and monitoring and evaluation

(M&E).

a) Planning: The central government, in collaboration with the

local governments, conduct regular planning on the implementation

of immunizations. Local governments are responsible for the

operation of immunizations, including the maintenance of cold

chain equipment. Number of supplies is calculated and prepared

based on local government’s annual proposal (to the central

government) on target beneficiaries.

(b) Supply: The central government is responsible for the supplies,

including Vaccines, Auto Disable Syringe), Safety Box,

Anaphylactic equipment, Cold Chain equipment, and Record-

keeping of immunization services. In relation to Cold Chain




equipment, it includes storage (cold room, freezer room, vaccine

refrigerator, freezer), vaccine transportation (cold box, vaccine

carrier, cool pack), and supporting equipment (thermometer, alarm,

etc.). Supplies of vaccines are managed by state-owned enterprises

(BUMN), appointed by the Health Minister.

(c) Distribution: Central Government distributes Vaccine, ADS and

Safety Box to Puskesmas through the provincial and district

governments, whereas Cold Chain is delivered directly to the

targeted locations. Other logistics distributed directly by the

Provincial and District Governments.

(d) Storage and Maintenance: Governments at the provincial and

district levels are responsible for the storage and maintenance of the

equipment and logistics of immunization programs, as well as

provisions for trained/qualified human resources to manage and

implement the program.

(e) Waste Disposal: For immunization conducted in Posyandu, staff

who conduct immunizations are responsible for collecting ADS

waste (vial and/or vaccine vial) into the Safety Box. The Safety Box

is then delivered to Puskesmas to handle and dispose the waste.

[Note: Puskesmas will be the key actor in pharmaceutical waste

disposal. Assessment on their capacity is crucial]

(f) Monitoring and Evaluation: Central government, provincial

and district governments are responsible for M&E.

[Note: Although the instruments are well-planned, M&E on the

implementation of waste management and disposal at Puskesmas is

not included].

Ministry of Environment and Forestry (MOEF) Decree No. 56 Year

2015 on Procedures and Technical Requirements of Hazardous

Waste Management from Health Care Facility.

Provisions:

- As part of Puskesmas Accreditation requirements, Health Care

Facilities (HCFs) are required to develop Standard Operating

Procedures (SOPs) in the handling of medical waste (solid and

liquid) and pharmaceutical waste.

- Environmental agencies at the district level are responsible for

the provision of permits on handling hazardous (solid) waste.

- For transportation, handling and disposal the permit is from

MOEF Jakarta.

- Bupatis can only issue permit for temporary hazardous waste

storage at the district level (if Puskemas has one).

MOH Regulation No. 27 Year 2017 on the Guidelines for

Prevention and Control of Infection in Health Care Facility.

Provisions: Safe handling and disposal of used syringes, including

the method of waste disposal (use of incinerator).




Program’s Priority Services: Water and Sanitation

3. Access to improved drinking water:

quality and quantity (continuity) of

water supply provision, weak

implementation of water quality control,

weak construction and supervision on

the implementation of the technical

guidelines for the construction of

community level water supply facilities.

Government Regulation No 2/2018 r.e. Minuimum Standard

Services (SPM) to achive the universal acess target 100-0-100.

Technical guidelines for the construction of community level water

supply facility (developed through PAMSIMAS and PNPM Rural).

MOH guidelines on parameters for water quality.

4. Access to improved sanitation facility:

Improper design practices on sanitation

facilities including non-compliance with

the safe distance requirement and the

lack of provisions for water supply to

toilets.

Technical guidelines for the construction of community level water

supply facility (developed through PAMSIMAS and PNPM Rural).

D.1.2 Social

37. There is no one system related to social performance. The assessment has focused on the relevant

provisions of the Village Law (Law No. 6 of 2014) and the key instruments that impact on the health, in

particular, sexual and reproductive health of women and girls, WASH, health and education service delivery

at the household and village level.

38. The Village Law: The new Village Law was issued in January 2014, replacing the previous Law No.

32 of 2004 on Regional Autonomy. The Village Law incorporates a number of key Community Driven

Development (CDD) principles and institutions, including participatory village planning, implementation

of village-level projects, inter-village collaboration, community facilitation and community oversight.

Under the Village Law, village governments are responsible for administering village funds (Dana Desa

and Alokasi Dana Desa)5 and accommodating community needs through democratic processes (hamlet and

village deliberations). The Village Law introduces an additional function of Village Councils (BPD, Badan

Permusyawaratan Desa) to supervise the performance of Village Heads (Article 55).

39. Reproductive and Sexual Health: Action to reduce stunting requires improvements not only in food

and nutrition security, education, access to water and sanitation, access to health services, but also in poverty

reduction and the status of women including on sexual and reproductive rights:

a. Early Marriage: The Marriage Law of 1974 establishes the legal minimum age for marriage at 16 for

girls and 19 for boys. In an attempt to increase the minimum age for girls to 18, this age difference was

recently challenged. However, the measure was rejected by the Constitutional Court in 2015. The

Commission on Violence against Women reported that the number of discriminatory national and local

regulations targeting women had risen to 422 in 2016 (from 389 at the end of 2015).6

b. Female genital mutilation/cutting (FGM/C) is condemned by many international treaties and

conventions as a violation of girls’ and women’s human rights. In Indonesia, the MOH issued a circular

in 2006 prohibiting female circumcision by medical professionals. However, in 2010, a new regulation

(PMK No. 1636/2010) permitted the practice (with the exception of “grave types of FGM/C”), if done

5 Explanation of village funds Dana Desa and Alokasi Dana Desa

6 Human Rights Watch (2017). “World Report 2017: Events of 2016.”


by medical professionals and based on the request or approval of a parent or guardian. The Women’s

Commission in Indonesia and Committee on the Rights of the Child consistently advocated against this

regulation and it was repealed in February 2014. However, there are no sanctions for individuals who

continue to conduct FGM/C and the practice remains widespread.7

40. Indigenous Peoples: The second amendment to the 1945 Indonesian Constitution enshrines state

recognition and respect for communities living by the customary law (Adat) and traditional value systems.

Subsequent laws, such as the Basic Agrarian Law No.5/1960 and the Forestry Law No. 41/1999 (with recent

revision through Constitutional Court Ruling No.35/2013) provide recognition to the rights of Adat

communities. However, these sectoral laws, including implementing presidential and ministerial regulations

are focused on land and natural resources, as such they are not relevant to the ESSA. The recent enactment

of the Village Law No.6/2014 also provides opportunities for Adat communities to strengthen their

participation, including managing development that addresses their needs and aspirations through support

from the village funds. However, guiding regulations with regards to Adat communities are still being

developed and further facilitation support is currently being provided to some degree by MOV at the village

level that corresponds to the needs of these communities. The Program seeks to strengthen village

facilitation through the HDW.

41. Indonesian laws use various terms to refer to Indigenous Peoples, including masyarakat suku terasing

(isolated tribal communities), masyarakat tertinggal (lagging communities), masyarakat terpencil (remote

communities), masyarakat hukum adat (customary law communities), and more simply masyarakat adat

(communities governed by custom). These communities usually live in forests, mountains and coastal areas,

and some are nomadic and sedentary and are dependent on natural resources. Since the program aims to

target 1000-day households, screening of these communities to determine whether or not they are indigenous

peoples becomes irrelevant and entails high transaction costs. The ESSA approach on Indigenous Peoples

has been very much informed by the imperatives for social inclusion and Indigenous Peoples’ ability to

participate in program interventions in a meaningful and informed way. Therefore, the challenges foreseen

with regards to Indigenous Peoples are not related to the legal framework pertaining to the rights of

Indigenous Peoples, but more on technical aspects within the Program to ensure that the approach and

engagement suits the needs and aspirations of these communities as well as the ability of the Program

interventions to reach these communities, who may live in remote areas or still live in a nomadic and

sedentary fashion, and therefore are hard to access. This will be further discussed in the section on findings.

42. Complaints handling: There is no one system for receiving and addressing any feedback or complaints

and that covers the five intervention packages:

a. Village level system: generally, the assumed rates of grievances with regards to the use of village

development funds and their use for the delivery of basic services show a lower rate of complaints than

expected in comparison to the earlier PNPM. There is no single channel for complaints handling at the

village level, but rather spread across multiple channels depending on the types of complaints,

perceptions of reliable mediation, relevance and severity of complaints against aggrieved parties.

Complaints at the individual agency tends to be more likely an ad-hoc affair and generally handled

without reference to standard procedures and without the allocation of resources (human and financial)

to manage complaints (World Bank Consultant Report, 2017). In an earlier study by the World Bank in

386 districts, the Village Community Empowerment and Development Agency (DPMD) was the

primary institutional unit for handling complaints related to village governance, followed by the district

inspectorate and secretariat (World Bank, 2016a). Misuse of village development funds dominates

complaints about village governance, followed by village boundary disputes, misuse of authority by

village officials, and village head elections.

7 UNICEF (2016). “Statistical Profile on Female Genital Mutilation/Cutting.”


In the current facilitation support provided by the MOV, complaints handling does not appear to form

part of the responsibilities of Village Law Facilitators. It was generally understood that these facilitators

are expected to report problems that they become aware of, but there is no specific assignment or

involvement in the actual dispute settlements for fear that they may damage their relationships with

villages. In the case of corruption, perpetrators are usually given an opportunity to return funds prior to

a case being processed in the court. Returns of funds would generally result in the case being closed

although social liability may remain (World Bank Consultant Report, 2017).

The role of the Village Council as a potential arbiter for complaints handling is also not clear; concerns

may arise regarding their public perception of reliability, limited authority and capacity to address and

accommodate complaints effectively.

b. Water and Sanitation: Since the INEY PforR is concerned over people’s access to water and sanitation

services, it can be reasonably assumed that multiple channels exist for people to lodge their complaints

with regards to water distribution, user fees, access to sanitation facilities, use of water resources, etc.

For central government programs implemented through the district agencies, such as PAMSIMAS with

the district Public Works Agency, a centralized Grievance Redress Mechanism (GRM) has been created

through SMS and/or online submissions (i.e. 081808952148/ www.PAMSIMAS.org) or alternatively

direct submission through the program facilitators. For WASH facilitation support provided by the

District Health Office (DHO), such as the CLTS, inquiries and complaints may be addressed to program

facilitators, cadres and/or sanitarians at the Puskesmas. Whether or not complaints handling for WASH

investments financed by village funds follows the same trajectory as village level complaints handling

systems remains arguable. One reason is attributed to the low rates of complaints on WASH issues in

villages visited for the assessment. If there are issues raised, e.g. unfair water distribution, extra user

fees, etc., resolution is likely to be an ad-hoc affair.

c. PAUD: Similar to WASH, division of authority in relation to complaints handling likely exist but

enforcement would vary. Level of interest in complaints handling related to PAUD services is low in all

villages visited. Complaints were usually not related to the services provided, but rather the amount (or

different amounts) of fees PAUD teachers/cadres received. Those who have been registered in the

District Education Agency, would usually receive slightly higher amounts compared to those recruited

locally by village governments although responsibilities are often the same. Complaints by PAUD

teachers are usually managed on an ad-hoc basis if at all.

d. Posyandu: There is no specific complaint handling mechanism for the delivery of Posyandu services.

Issues and complaints are treated to be ad-hoc affairs. Only in rare circumstances where such services

led to serious adverse events such as illness post vaccination, would complaints be directed to

Puskesmas staff or through their midwives or directly to the District and Provincial Health Offices

(DHOs and PHOs) or to a higher level, such as MOH. Communities are encouraged to report to

administering health facilities and/or DHOs and PHOs in the event of maltreatments and/or adverse

impacts leading to fatalities and/or serious side-effects following vaccination (Chapter 41 of MOH

Regulation 12/2017). Independent committees, namely Komda PP KIPI at the provincial level and

Komnas PP KIPI at the central level, are established by respective governments (Minister and

Governors) to investigate post-immunization adverse events and/or incidents. Each commission is

comprised of relevant medical specialists. Respective health facilities are responsible to investigate and

report the results to the heads of DHOs and PHOs, who will then pass the investigation results to Komnas

KIPI and Komda KIPI for further examination and reporting to MOH. By rule, the government shall

bear the costs for investigation and remedial measures in the event of maltreatments (Chapter 42 of

MOH Regulation 12/2017).

43. Consent processes for administration of vaccines: parents and caregivers have the right to refuse

vaccines provided by the government. Every health facility, including Puskesmas, is required to ensure that

communities in their catchment areas are well-informed (Chapter 5 of Government Regulation 32/1996)


about the use of vaccines, possible side-effects, possible effects for not administering vaccination as well as

necessary mitigation measures. Following socialization, enrolment of families and caregivers at the time of

vaccination can be construed as approval and there is no requirement for written consent (Chapter 2 of MOH

Regulation No 290/PER/III/2008).

D.2 Institutional Responsibilities

44. The key institutions involved in the delivery of the INEY PforR are presented in the table below:

Table 3: Key Institutional Stakeholders for the Program.

Interventions National District Village

Nutrition-Specific

Interventions

- Ministry of Health

(MOH - DG-P&MD,

DG-PH)

- District Health Offices

(DHOs)

- Puskesmas (sub-district)

- Posyandu

- Village Governments

- BPD

- Frontline service

providers

Nutrition-

Sensitive

Interventions

- MOH (DG-PH)

- Ministry of Education

and Culture (MOEC –

DG-ECED)

- Ministry of Social

Affairs (MOSA – DG-

PFM)

- District Education

Offices (DEOs)

- District Social Agencies

- PAUD

- Village Governments

- BPD

- Frontline service

providers

D.2.1 Environment

45. Under the INEY PforR, the main institutions involved with environmental management include MOH,

MOHA, and MOEF. The table below describes roles and responsibilities of the institutions in managing the

potential environmental risks.

Table 4: Institutional Roles and Responsibilities for Environmental Performance.

Institutions Institutional Roles and Responsibilities

Ministry of Health

(MOH):

- Directorate of

Primary Care

- Directorate

General of

Community Health

- Directorate

General of Public

Pharmaceutical

and Health

Supplies

Posyandu or Pos Pelayanan Terpadu (an integrated service centre for maternal and

child health related services) is a monthly clinic for children and pregnant women; a

volunteer-led community health services in Indonesia. The centre aims to provide basic

health services such as family planning, mother and child health, nutrition (including

vitamin and mineral supplementation), immunization and disease control (diarrhoea

prevention). The centre is operated by volunteers who are called village health workers

or cadres (Kader) who are selected from community members and trained by medical

doctors or midwife from Puskesmas (Pusat Kesehatan Masyarakat or primary health

centre) – a sub-district representative of the MOH to perform basic health care services

needed.

Implementation of Posyandu requires inter-sectoral collaboration between MOH and

MOHA.

Ministry of Home

Affairs (MOHA)

MOHA provides supports to Posyandu.


Institutions Institutional Roles and Responsibilities

Ministry of

Environment and

Forestry (MOEF)

In coordination with local government (environment agencies of the province and

district) to monitor the implementation of regulation related to medical/pharmaceutical

waste management; to issue the permit for medical waste handling companies; to

provide guidance and advise on medical waste management

D.2.2 Social

46. Village Government: The key stakeholders for addressing social performance are the village

government, and the village and household level healthcare and early years education providers.

a. The structure of village governments is comprised of village heads who are democratically elected every

five years and is assisted by a village secretary and section heads of village governance, welfare and

basic services. At the hamlet level, the village governments are supported by hamlet heads (Kadus) in

the running of village government affairs and community mobilization. Outside the village government

system, the role of the BPD mirrors legislatures to represent communities and advocate their aspirations.

The BPD are responsible to 1) discuss and agree on village regulations with village heads, and 2) collect

and extend community aspirations so that they are accommodated in village planning and budgeting

processes.

b. Village governments play a critical role to ensure availability of nutrition-specific and sensitive

interventions at Posyandu and PAUD. Under the Village Law, village governments are responsible to

administer village funds (Dana Desa and Alokasi Dana Desa)8 and accommodate community needs

through democratic processes (hamlet and village deliberations). The role of village governments in

mainstreaming health and education into village development plans (RKPDes) and village development

budget plans (APBDes), including in determining budget allocation and/or directing how allocated

budget is spent, is critical and may continue to become stronger in the coming years.

47. WASH: Under PAMSIMAS9, the delivery of improving access to water, sanitation and hygiene at

village level is in two parts; infrastructure instalment (simple water treatment systems, pipeline, toilets and

hand-washing facilities) and community led behaviour change around good hygienic practices. Although

district governments assist in identifying the poorest villages, village communities must provide funding to

purchase program benefits. Villages must elect members to form the BPPSPAMs and PAMSIMAS

facilitators that are responsible to facilitate sessions on good hygiene practices in collaboration with frontline

health and education providers. Village-level BPPSPAMs will represent at the district level BPPSPAMs to

share knowledge and best practices. Under the INEY PforR, the Convergence Program will focus on

convergence of non-infrastructure WASH investments, specifically improving behaviour change to increase

uptake of hand washing programs and achieving Open Defecation-Free status.

48. Frontline health services: Nutrition-specific interventions supported by the Program (see Annex 6,

Social) are administered by Puskesmas (public primary health centres)10 and their auxiliary and outreach

services. The public primary care system also includes 23,000 auxiliary Puskesmas (Pustu) for outreach

activities in remote regions, village-level delivery posts (Polindes, often the home of the village midwife)

and village health posts (Poskesdes). Frontline service delivery in the more than 75,000 villages across

Indonesia is also undertaken through Posyandu and by village midwives (who are formally part of the health 8 Explanation of village funds Dana Desa and Alokasi Dana Desa

9 PAMSIMAS is moving towards the achievement of its development objective. As of February 2017, the larger Project has provided around 1.8

million people with access to improved water facilities and access to improved sanitation in around 2,251 villages. About 56% of target communities

have reached an open defecation free (ODF) status, about 72% have adopted hand washing programs, and more than 87% of targeted schools had

improved their sanitation facilities and hygiene programs. 81% of villages had efficiently managed and financed water supply facilities. DFAT

Grant has supported the project to strengthen capacity building and sustainability as well as disability inclusion. 10 There are approximately 2,400 hospitals in Indonesia and about two-thirds of them are private. The public health care system is decentralized to

the district level with about 9,767 Puskesmas forming the backbone of Indonesia’s health system.


system). Posyandu is a monthly event manned by at least five types of community health workers that cater

to the five essential services: registration, weighing and monitoring children’s growth, recording of child

growth in health cards, counselling and education; immunization and ante and post-natal care (ANC and

PNC) as part of outreach services of Puskesmas. Cadres - who work on a voluntary basis - are not part of

the formal health system and do not receive monthly salaries (only minimum transport allowance from

DHOs or village governments)11.

49. Midwives and nurses are important frontline service providers due to their placement and/or operations

at the village level and therefore, are more accessible compared to doctors who are mainly based in

Puskesmas at the sub-district level12. In addition, midwives and nurses are usually permanent workers with

monthly pay-rolls or paid by villages. Following the roll-out of the Program Nusantara Sehat (Healthy

Indonesia Program)13, it is anticipated that the number of midwives will increase, however distribution

remains an issue. Since many of the midwives met are being assigned to multiple villages, their level of

engagement with village governments is more limited compared to their cadre counterparts. However, they

may have more power to influence due to their technical expertise.

50. PAUD: The delivery of ECED is administered by

village-level PAUD centres for children aged 0-6

years14 (MOEC Ministerial Regulation No 137/2014).

These centres are run by PAUD teachers who serve on

a voluntary basis. PAUD teachers who are registered

with the Education Agency are entitled to financial

incentives of 500k IDR per month and opportunities to

participate in training. If PAUD teachers are recruited

by the village, they are entitled to a lesser fee of 200k

– 300k IDR (varies between villages) from village

funds that is paid every 6 months depending on village

funds withdrawal. This gap in fees exists despite the

same work responsibilities. PAUD cadres work in 3-4

half-day sessions per week. PAUD services are

demand-driven and there could be a lack of incentives for PAUD teachers to outreach to tend to children

due to existing burdens. Although the prescribed ideal ratio for PAUD teachers to children is 1:15 (one

teacher is responsible for 15 children), this ratio is often considered unrealistic and too high. With regards

to capacity building, PAUD teachers are entitled to receive 200 hours of training from the Education Agency

per year, and gain access to peer support learning on a monthly basis, facilitated by Kelompok Kerja Guru

(Teacher Peer Support Group) from the sub-district. Classroom materials are funded and provided by the

Education Agency, or through Dana Desa. Parents do not usually contribute funds or payments to PAUD

services. There have been instances when a community voluntarily contributes small amounts to PAUD

centres to support their activities however this is not common.

11 These cadres usually consist of village volunteers who work in collaboration with Puskesmas staff at the village health posts (Posyandu). Posyandu

runs monthly check-ups and health promotion activities, usually for pregnant mothers, infants and the elderly.

12 Frontline health services are mainly delivered at the Puskesmas and village health posts (Pustu). However, these centers suffer from absenteeism. Doctors do not stay in rural areas and only 70% of midwives remain in villages, and the remaining 30% migrate to cities (the National Research

Council 2013).

13 Following the discontinuation of the PTT program (temporary deployment of doctors, midwives, and dentists), the Ministry of Health (MOH) launched the Nusantara Sehat Program (Healthy Indonesia Program) in 2016 to deploy health workers on special assignment (two years on a rolling

basis) to fill health workforce gaps in Puskesmas in targeted locations, particularly in remote, lagging or border areas, and locations facing health

issues within the four priority areas of the NSP. The NSP deploys two types of health workforce (i) team based special assignment consisting of at

least five health worker categories, albeit with varying combination in response to local needs, and (ii) individual health workers.

14 PAUD centers are also referred to as Taman Kanak-Kanak (TK), Taman Kanak-Kanak Luar Biasa (TKKLB), Kelompok Bermain (KB), Taman

Penitipan Anak (TPA) and Satuan PAUD Sejenis (SPS). TK are for children aged 4-6 years; TKKLB are for 4-6 years with priority to 5 and 6; KB

are for 2-6 years with priority to 3 and 5 years; TPA are for 0-6 years; SPS are for 0-6 years (Article 1 Ministerial Regulation No 84/2014).

Box 1: Perceptions of PAUD

In Talaud, tendik PAUD explained that many parents

were not convinced by the benefit of PAUD, adding

that it is perceived as playtime and children are sent

to attend PAUD so that mothers have the household

to themselves for a couple of hours and to “keep

them out of trouble”.

Some tendik requested small contributions for extra

classroom materials. However, parents did not

comply because they did not bring the children in

every day and could not see the benefit.


E EXPERIENCE FROM PREVIOUS PROJECTS

51. The World Bank has been supporting the GOI to expand access to basic health and education services

under the GSC. The program was previously part of the PNPM, executed by MOHA. Following the

establishment of the MOV, the program has been implemented by MOV. The program previously provided

small-grants to communities to support availability and access to basic health and education services.

Following the enactment of the Village Law in 2014, the program was re-designed to provide technical

assistance and capacity building support to GSC villages to help them better use village funds for basic

health and education services. The program’s transition from MOHA to MOV presented challenges in

program implementation and ensuring proper oversight, including safeguards. As a new ministry, MOV has

been tasked with a critical responsibility to manage village funds across villages in Indonesia. This has

consequently impacted the level of coordination and quality of program implementation. The Person-in-

Charge for safeguards at the PMU (Project Management Unit) has changed multiple times and the program’s

GRM was only recently reactivated in 2016. Given the program’s planned phase-out in the end of 2018, the

program is currently undergoing a restructuring to support a HDW pilot, which aims to provide capacity

building support to frontline development workers to mobilize communities around stunting interventions

whilst supporting integration of GSC activities into village planning and budgeting. It is envisioned that the

HDW will be the main mechanism through which the Convergence Program will, via districts, support

village governments to identify, implement and monitor intervention delivering to “first 1,000-day

households” in each village.

52. A review of then PNPM Generasi (now GSC) found that even though it has a strong focus on women

and children, it missed opportunities for well-rounded gender integration. One omission has been the

absence of fathers in PNPM Generasi interventions. By focusing so exclusively on the role of women as

mothers and by excluding fathers from the process, important roles that fathers can play are missed. The

assessment also highlighted women’s low status within the community and their lack of confidence to make

active and well-informed health choices as key concerns. In summary, issues of men’s participation and

women’s empowerment (rather than numeric participation) are key gaps for PNPM Generasi.

53. Crucial to effective service delivery under the Convergence Program, will be effective prioritisation

and allocation of village funds to health and education services at village level. To support village planning

processes and governance over village funds, the World Bank is supporting MOV in implementing Village

Innovation Project. This program is supporting the transition from PNPM to Village Law systems, and will

be increasingly important to facilitate documenting and monitoring of village spending.

54. Other previous and on-going government programs supported by the WB relevant for the INEY PforR

would include PAMSIMAS and PNPM Rural and Urban. Lessons learned on the implementation of

environmental management systems through these projects indicate substantial provision on practical tools

in managing and mitigating potential environmental risks and impacts. These tools were instrumental to

assist community facilitators and village governments in integrating environmental considerations into

village-level development. Under PAMSIMAS, grants are transferred directly to communities for local

water and sanitation infrastructure and technical assistance. PAMSIMAS program activities will continue

until December 2020. The Convergence Program will consolidate and implement lessons learnt from these

interventions.

55. Under the umbrella of PNPM Rural, PNPM Green was developed and implemented by MOHA. The

project enabled the implementation of an environmental management strategy aimed at achieving more

sustainably managed natural resources. The strategy included mainstreaming environmental considerations

into village level investment choices which led to activities (or sub-projects) that are not only

environmentally benign but that also proactively improve the environmental conditions in and around

project villages. Maintaining and improving the natural capital is an important component for maintaining

and improving natural resource related livelihoods, rural economies and the security of rural communities.


56. The World Bank has also supported GOI to expand and strengthen access to social assistance under

PKH (National Social Assistance Program). These conditional cash transfers are tied to specific

requirements that incentivize communities to utilise health and education services15 in the villages thereby

increasing demand for these services and improving education and health outcomes in the long-run. In 2017

the World Bank provided finance for this program to strengthen program delivery, improve inclusivity and

support expansion from 3.5 million to 15 million by 2020. The program is implemented by MOSA in

collaboration with other line ministries at national and local level.

15 In the area of health, PKH’s indicators focus on improving mothers’ attendance to village health nters (Posyandus), which provides basic health

check-ups and counseling by midwives and occasional distribution Fe tablets and supplementary feeding. In the area of education, PKH aims to

stimulate school children’s attendance and such an intervention.


F CAPACITY AND PERFORMANCE ASSESSMENT

F.1 Environmental Considerations

57. Institutional capacity to implement the environmental management system for the INEY PforR is

highly dependent upon the level of assessment on the following criteria. Annex 5 provides the overall

assessment of capacities in implementing the relevant policies:

a. The provision of policy and legal framework. It is crucial that such provision is in place within the

government’s legal framework. National guidelines, policies and regulations related to mitigation

measures and management of environmental related issues and risks are available. These provisions are

critical in setting the institutional boundaries for policy implementation.

b. Institutional arrangement: Availability and capacities of human resources are crucial in ensuring

relevant policies and regulations are well implemented. Consultations with relevant ministries and

agencies indicate that policies and regulations on environmental management are broadly understood

and recognised. However, capacities to implement remain an issue.

c. Budget for improved capacity: Availability of budget provision for training, monitoring supervision of

the implementation of the policies is instrumental in ensuring policies and regulations are well

implemented. The training budget for midwives is proposed by District MOH to be allocated by BKPPD

(Badan Kepegawaian Pendidikan dan Pelatihan Daerah) at district level. ESSA team has encouraged

the national level stakeholders to ensure availability of budget within current respective program for the

purpose of capacity building.

d. Monitoring and supervision: Level of monitoring and supervision plays a major role to ascertain the

implementation of the guidelines, policies and regulations (i.e. Quality Control). Consultations with

relevant ministries and agencies highlighted that there is a need to improve and strengthen the

monitoring and supervising roles of the relevant agencies, in particular at the district level.

58. Potential environmental adverse impacts and health hazards to staff, patient and public/community

from primary healthcare (PHC) providers such as Puskesmas and Posyandu that will support INEY program

have been identified and regulated to be equivalent with Good International Industry Practice. The

immunization activities and provision of food supplement, medicine/vaccine could produce hazardous

medical waste such as infectious waste, sharps/needles, expired vaccines/medicines and other solid and

liquid waste. Ministry of Environment and Forestry Decree no 56/2015 regarding Medical Waste

Management of PHCs clearly regulates the management of medical waste such as the separation system,

labelling, storage, transportation, disposal and permitting requirement including the efforts in waste

reduction and competency/capacity building. This decree is comprehensive and equivalent with the World

Bank Environmental Health and Safety (EHS) Guidelines for Health Care Facilities. Ministry of Health

Decree 46/2014 regarding PHC accreditation and Decree 75/2014 about Puskesmas regulate these aspects

in more detail.

59. Government regulations stipulate pharmaceutical/medical waste as hazardous waste due to its

infectious characteristics. Licenses are required for any activities relating to temporary storage,

transportation, utilizing and disposal/treatment of waste. Within this regulatory framework, the sub-national

governments have only the authority to issue permit for temporary storage while other activities are managed

by the MOEF at the national level. With regards to licensed hazardous waste disposal facilities, the

Government of Indonesia has one facility which is located in Cileungsi Bogor, operated by PT. PPLI – a

joint ownership between private company and MOEF and operated since 1994. In particular for medical

waste handling and treatment, at current there are only 6 (six) medical waste treatment service companies

in Indonesia, mainly are located in Java island. In 2017, MOEF established a pilot medical waste treatment

facility in South Sulawesi in efforts to cover eastern Indonesia region.

60. A site visit to a certified Puskesmas in Cikalong, a consultation with environmental health staff at

DINKES Cianjur district, and a discussion with the local environmental agency (BLH) revealed that; (i)


special bins for medical waste and expired medicines/chemicals, disposal boxes for sharps/needles with

proper handling for labelling, including storage and transportation are sufficiently supplied; (ii) dedicated

staff are available and competent in providing training to primary care providers on the implementation of

the relevant regulations; (iii) there is close collaboration between DINKES and BLH in implementing the

regulations including problem solving when abnormal conditions arise; (iv) the procurement of auto-disable

syringes has been promoted by DINKES to primary care providers; and (v) the provision of Circular Letter

No 861/2017 from the National Accreditation Committee stipulates the requirement from International

Society for Quality in Health Care. This has been adopted by the Accreditation Committee to implement an

absolute requirement to have a permitted medical waste treatment facility in hospital. If during certification

the permit/facility was not found, the certificate award will be deferred for 3 months for evaluation (Circular

Letter No 861/2017).

61. The site visit identified several challenges with regards to the implementation of the above regulations

at village level. Posyandu and Puskemas are not equipped with proper transportation devices as regulated in

MOEF Decree 56/2015. In some cases, the mid-wifes or sanitarian use personal car, motorcycle, or local

ambulance to bring medical waste from Posyandu to Puskemas or to a permitted waste storage facility. They

are all aware of such risks and based on the information from the workshop the strict adherence to the

regulation from the staff is still lacking and need to be continuously reminded. . The program will support

coordination and converging efforts to all relevant activities under INEY Program along with other existing

program related to Puskesmas and Posyandu such as the Puskemas Accreditation program under I-Sphere

PfR, DAK Penugasan Kesehatan, Dana Desa etc.

62. A site visit in Kamurang village, where stunting was found, suggests that water and sanitation facilities

remain a significant issue. The lack of available facilities means that some people use their backyards (or

nearby creeks) as an alternative to the use of toilet. And in some cases, it extends to the use of local creeks

where community members collect their drinking water supply. The DAK allocation for water and sanitation

is also very low, approximately 2-3% as compared to education and family planning allocation. The issue

with the sustainability and the operations and maintenance of the facility was also discussed during the

worhsop with representatives from 5 districs (see Annex 3).

63. It is highly recommended that several waste reduction efforts and an integrated solution and

coordination for medical waste management handling (among relevant agencies at district level) is initiated

under the INEY program in cooperation with I-Sphere program. The use of needle destroyer or needle cutter

can be implemented to reduce the generation of medical waste from Posyandu/Puskemas. Also, the training

on how to implement a proper burial technique for remote Puskesmas as per PermenLH 56/2015 was also

discussed during the workshop (Annex 3). From the discussion with BLH staff, a draft PERDA is being

prepared to regulate waste management in Cianjur including hazardous waste management. The mission

suggested that early consultation with relevant agencies (such as primary care providers (including private

clinics/hospitals), MOEF, development partners, waste transporter companies including civil society

organizations and expertise/academics in this field) should be undertaken prior to the enactment of the

PERDA. However, it is important to note that INEY intervention has its own limitation and boundaries that

shall be further carefully assessed before getting involved with such types of coordination efforts.

F.2 Social Considerations

64. Social effects to be assessed were informed by the INEY program objective of increasing simultaneous

utilization of nutrition interventions by 1,000-Day Households in priority districts. The social considerations

were: community participation; inclusion of targeted beneficiaries including interventions that consider

beneficiaries’ specific context, vulnerability and marginalisation to enable them to understand and

participate in an informed manner; complaint and feedback handling; and informed decision-making and

consent processes.


F.2.1 Role of Village Government, Posyandu, PAUD and Community Participation

65. The role of village governments in mainstreaming health and education into RKPDes and APBDes,

including in determining budget allocation and/or directing how allocated budget is spent, is critical and

may continue to become stronger in the coming years as observed in Talaud. Such an increase may have a

linear correlation with a combination of advocacy, facilitation, enabling regulatory and policy environments

on the use of village funds, and sustained community demand for basic services. However, there is often a

lack of presence of BPD in the running of village governance. Although the current law positions BPD in a

strategic position to advance community aspirations, initial findings from the World Bank-supported

Sentinel Village Study (SMERU, 2017) indicate that BPD’s limited capacity to engage in village planning

and budgeting, despite their physical presence in these processes, limits their intended roles and functions.

66. As part of the ESSA, the World Bank visited Talaud District. Across Talaud, villages, especially where

GSC operates, have steadily increased their allocation of village funds for health and education services

especially (see Table 5). Such an increase may have a linear correlation with a combination of advocacy,

facilitation, enabling regulatory and policy environments on the use of village funds, and sustained

community demand for basic services. The assessment observed that the role of village governments was

more articulated in directing the “hardware” of basic services, such as construction of basic infrastructure

and/or procurement of equipment needed to run such services. Their role tends to diminish and/or become

less articulated in managing the “software” of these services, such as capacity building, targeting of

beneficiaries, spending on specific inputs for services, such as food supplements. The current guideline for

PAUD dictates that village governments and community representatives are responsible to guide and

oversee the implementation of PAUD through oversight and advisory committees (Tim Pemantau and Tim

Pembina respectively). This raises questions whether this role is effectively enforceable within the current

divisions of responsibilities.

Table 5: Share of Health and Education-related Activities in APBDes in the District of Talaud.

Year Health related activities* Education related activities*

2015 1.98% -

2016 8.40% 4.26%

2017 8.62% 6.15%

*as a share of village funds in APBDes, specific expenditure items were not known. source: GSC’s profile in Talaud

67. On village planning, Musrenbangdus (hamlet deliberation) was perceived to be more participatory and

receptive to proposals from various community groups. Through this deliberation process, a long list of

proposed activities will be produced by each hamlet and subsequently short-listed and will subsequently

compete with other hamlets during Musrenbangdes (village deliberation). The winning proposals will form

the basis for the development RKPDes led by a team named Tim 1116. Following the finalization of RKPDes,

APBDes (village budget plans) will be developed once indicative ceilings of village funds from Dana Desa

and Alokasi Dana Desa are known. A relevant question would be how community participation influences

final allocation of village funds into specific expenditures rather than to what extent village planning

processes are participatory. Several potential determinants were identified including:

a. As Musrenbang Desa is often understood by community members as a ranking exercise for hamlet

proposals, the running of the Musrenbang Desa would likely resemble a negotiation rather than a

consultative process. This perception has implications with regards to what extent community members

can change or add to existing proposals. Cadres and GSC beneficiaries met during the assessment

explained that although activities around maternal health, education and nutrition were prioritized

16 Often dubbed as Tim 11, this team is a think-tank team established by community members through a democratic election to formulate village

plans and budget allocation. The figure 11 is usually associated with the PNPM’s TPMD (village community empowerment team) although by law

the minimum composition is 7 representatives.


during Musrenbang Dusun, final decisions were often steered by men and respective figures during

Musrenbang Desa;

b. Observations indicate that inclusion of spending on basic services in the APBDes by village

governments may be influenced by peer-pressure or advocacy by certain individuals (e.g. cadres,

midwives, or facilitators) rather than the voices of citizens;

c. Regulatory obedience could be a stronger determinant than community participation. Given the recent

signing of an MOU between the MOV and the Police and Military to monitor village funds, such

paranoia may worsen;

d. Instructions by higher level governments, for instance Bupati, tend to be more effective in mobilizing

efforts around certain priorities than generating community demand for services. District heads may

mobilize their power through district agencies that facilitate or verity RKPDes and APBDes to influence

village decisions on village funds.

68. A case in point is that community participation indicators per-se may not necessarily reflect how

decisions are made at the village level. However, fostering community participation in hamlet and village

planning processes may increase communities’ awareness about their rights and subsequently citizens’

demand for basic services and therefore, could help hold village governments accountable. Integration of

social mapping tools in Musrenbang Dusun and Musrenbang Desa spearheaded by the GSC is one of the

examples how this can be done.

69. The social mapping tools introduced by the GSC to the village planning processes present opportunities

for villages to prioritize spending on their community members who are considered poor or in need for

support. However, translating community needs for basic services identified in these social mapping

processes into unit costs could be challenging, let alone projecting financial requirements for specific

expenditures (e.g. support to high-risk pregnancy and malnutrition) and negotiating these during APBDes

formulation, which was often developed by the Tim 11 in a closed space. In addition, the success of this

social mapping exercise may be dependent on the facilitation skills of facilitators. The transition from the

GSC facilitation to possibly the village law facilitation (P3MD) may present risks, not only in terms of

shortages of skills, but also lack of prioritization since the current P3MD facilitators are likely to be occupied

by administrative support to village governments or simply not available due to high attrition and/or

absenteeism. A focus on identifying the poor in these social mapping processes may also risk excluding

stunting cases in families and/or households who may be perceived to be well-off. Alternatively, there may

be potential for elite capture and if processes are not transparent there is the potential for inequalities in the

distribution of services in particular nutritional products. The social mapping tools will focus on 1,000 day

households regardless of their socio-economic, ethnicity, indigenous, religious and cultural status.

70. For programs managed by Puskesmas, such as vaccination, nutrition interventions for malnourished

infants, or sanitation programming (e.g. CLTS, Community-led Total Sanitation), targeting would rely on

midwives and Puskesmas staff who usually collect data from Posyandu cadres and/or in some instances,

village governments. Posyandu is particularly an important platform for village-level targeting processes

since cadres would usually report to midwives and Puskesmas staff if malnutrition cases or mothers with

high-risk pregnancy are found and/or reported. Such targeting may be more accurate and updated than the

UDB (Unified Data Base)17 or any government targeted database since village community members

themselves provide the information in a more regular basis. However, there could be a limit with regards to

17 The UDB is an electronic data system containing social, economic and demographic information on around 24.7 million households or 96.4 million individuals in the poorest 40 percentiles across Indonesia. Households’ welfare status was ranked using the variables of household welfare

obtained during PPLS (Data Collection for Social Protection Programs) Survey 2011 conducted by the Central Bureau of Statistics (BPS) and using

proxy means testing (PMT) models to determine the relative poverty of households for each district/municipality. The PMT models predicted households’ income by collecting simple information about the assets they own and were tailored to each district and municipality to accommodate

variable differences (TNP2K 2015). The consumption index generated by the PMT models was used as the basis to rank households based on their

welfare status. To date, the UDB is considered to be the most comprehensive targeting database in the country.


what extent and types of information relevant to stunting that can be generated through Posyandu growth

monitoring indicators.

71. During the mission to Ketapang, the World Bank joined the Ministry of Health’s Monitoring and

Evaluation Mission to Ketapang, where national, provincial, district agencies and village governments

gathered to share statistics and analysis on stunting in the district, it was revealed there were discrepancies

in stunting data held by village governments and district agencies, whereby data on stunting cases held by

Posyandu did not accurately reflect the reality in the village. This may be due to a gap in knowledge over

how to measure stunting (infant and child height) at Puskesmas and Posyandu level. With an inaccurate

picture of stunting statistics in villages, this runs the risk of inaction or wrong action towards solving the

problem. In order to increase transparency over this and thus correct action by village governments and

service providers, it would necessitate further capacity building for cadres and Puskesmas staff,

development of simple measurement tools/methods for stunting, monitoring protocols and improved

communication between village governments and district agencies.

72. The functioning of Posyandu varies in terms of levels of efforts and quality of outreach services.

Households in higher income brackets tend to show lower participation in Posyandu activities (Nazri et. al

2016). Several factors may explain such behaviour, including 1) mobility patterns where wealthier mothers

and/or caregivers are more likely working outside home; 2) limited incentives to access Posyandu services

due to their association of being poor; and 3) ability to access other options, including private health services.

Perceptions of reliability and benefits of Posyandu services influences mothers and/or caregivers’ attitude

to Posyandu. This suggests that a combination of improvements of service quality and social marketing

(supply and demand side) has the potential to increase use of Posyandu services.

73. Outside the recognized health system, the

assessment also found that Traditional Birth Attendants

(TBAs) still play an important role in the delivery of basic

services, particularly in counselling, assistance to

delivery (now increasingly performed by midwives) and

post-natal care. Since the current regulations outlaw the

practice of TBAs in performing delivery, their roles are

diminishing. Some of the trained TBAs are given new

responsibilities to assist midwives in delivery and provide

post-natal care for mothers, with incentives from

BPJS/Jampersal (maternity health insurance) claims

agreed with respective midwives. In some of the villages

visited, some of these ex-traditional birth attendants

assume a new role as Posyandu cadres and therefore their

presence is recognized by formal health service providers

and could access training. Community perceptions

around changes associated with mainstreaming modern

medical practices and how this could create social tension

and/or conflicts with service providers outside the formal

system will be monitored as part of the INEY PforR.

74. In terms of the possibility for PAUD being used as a counselling platform for parents around nutrition

and child rearing, the assessment observed that there could be some resistance from PAUD teachers if

parents stay during the sessions. It would, therefore, be necessary to find optimal times for PAUD teachers

to host sessions which parents could join. Given that teachers will be doing extra outreach to target and

invite priority families, and host parenting and practical learning sessions, their workload will increase quite

significantly, and this would necessitate appropriate compensation and incentives. Teachers would usually

encourage parents to leave to foster independence of their children and efforts to invite families should be

supported by village governments, service providers and facilitators.

Box 2: Births Attended by TBAs

Occasional incidences of births assisted by TBAs

were reported in Talaud. However, the frequency

could be higher due to various reasons, such as:

- Pregnant women may feel more comfortable

since traditional birth attendants are believed to

have more experience and possess spiritual

powers and knowledge of traditional medicine;

- Village midwives are sometimes young and lack

experience so are not trusted. Some of these

midwives may come from outside the village

and therefore may not be familiar with the

culture and local languages;

- Services are provided at home and therefore

cheaper, especially in places far away from

Puskesmas; and

- Some TBAs offer extra services by doing

household chores while mothers recover.


75. Water and sanitation: No infrastructure in supported under the program boundary and the Village

Convergence Scorecard is aimed to understand peoples access to water and sanitation.

F.2.2 Inclusion and Behaviour Change

F.2.2.1 Gender

76. It will be critical to understand how gender roles and relations interact with interventions to influence

child health and nutrition outcomes and to consider how to involve men and adolescent girls as well as well

as pregnant women and mothers in interventions. Programs to combat or reduce stunting in children should

focus on both men and women, as responsible caregivers and decision-makers. Additionally, involving

adolescent girls in interventions will be key to generating desired behaviours for later stages of life.

77. Informed women who have greater influence in decision-making and agency in access to and control

over information, incomes, and resources (including food) are statistically less likely to have malnourished

or stunted children (UNICEF, 2011). If women are the caregivers, then the decision-making power and

access to and control over resources are key as they form the basis of women’s bargaining power within the

household. There is correlation between stunting and wealth of the household. There is evidence that a

mothers’ ability to seek treatment for children is closely related to her ability to access resources (including

food) both independently and from others within the household. Generally decision-making on resources is

made by men and senior household members including mothers-in-law, as well as deciding about well-being

of the child and the need to seek assistance from outside the home. A mother’s ability to pay for costs and

treatment, herself, may also influence the decision-making. Divisions of labour can present a heavy burden

on women with potentially negative impacts for child health and nutrition outcomes.

78. Poorer families, lesser educated mothers, young mothers, older mothers, unmarried mothers, single

parent families or child headed households, and parents with HIV status are likely to be the most vulnerable.

Reduced stunting and malnutrition is positively correlated with women’s empowerment.

79. In the poorest households in Indonesia, it is likely that more money is spent on tobacco than on

education and health care combined. Smoking exacerbates the effects of poverty, as expenditures for tobacco

may divert household income from food, clothing, housing, health and education (Semba et al, 2006). In

2013, smoking prevalence among males was 66%, while among females was 6.7%. Smoking prevalence

among children ages 10–14 in 2013 was 3.7%, twelve times higher than in 1995 (IAKMI, 2014; Ahsan,

2015).

80. Education status of mothers is also a key factor in preventing stunting. There is a strong evidence base

on the link between women’s education and child survival generally and this also is shown to be the case in

Indonesia where there is a link between the mother’s education level and stunting. It would also be

interesting to understand how or why education makes such a difference for example education may enable

ability to better negotiate systems for healthcare or village level decision making. It is also likely that a

woman with higher education may have greater direct access to resources through improved income earning

potential and increased indirect access to resources and decision-making power through improved status in

the household as well as the community level. It would be useful to understand if there are differences with

education level of mother and stunting based on urban and rural areas. Urban versus rural settings may have

different structural and traditional expectations of women. There is also potentially a gap in the information

on paternal education and effect on child health and nutrition.

81. Child marriage in Indonesia has plateaued, but it remains persistently high with over one in four girls

currently marrying before reaching adulthood. Marriage of girls under the age of 16 and 15 has declined

since 2008 to 3.5% and 1.1%, respectively; however, marriages among girls aged 17 and 16 has remained

roughly the same (20.2% of marriages in 2008 and 19.3% of marriages in 2015) (UNICEF, 2016). One of

the key drivers of child marriage is rigid gender norms (Plan International, 2015). Poverty makes girls more


vulnerable to child marriages, but social and cultural acceptance of the practice permeates all economic

levels. In 2015, nearly one in eight girls who married before the age of 18 were from households with the

highest levels of expenditure in Indonesia (UNICEF, 2016). Child marriage in Indonesia is estimated to

have caused a loss of at least 1.7% of GDP in 2014 (UNICEF, 2015). Discriminatory laws, customs and

practice such as early marriage result in inequalities that can affect nutrition and stunting. When girls marry

early this results in early pregnancy, often in malnourished mothers, and low weight births (UNICEF, 2011).

Married girls tend to have poorer educational, economic, and health prospects. This limits their ability to lift

themselves out of poverty and increases the likelihood of passing on similar circumstances to future

generations. Undernourished girls have a greater likelihood of becoming undernourished mothers.

82. Various forms of female genital mutilation/cutting (FGM/C) continue to be practiced in Indonesia. In

2013, nationally representative data on FGM/C were collected through a survey of nearly 300,000

households in 33 provinces and 497 districts. This Basic Health Research Survey (RISKESDAS) was

implemented by the MOH’s National Institute of Health Research and Development and asked questions to

caregivers or guardians of each female household member up to 11 years old. Findings from the survey

indicate that nearly half of girls under the age of 12 have undergone some form of FGM/C, the majority of

whom were under 6 months of age at the time (3 out of 4). This is high in comparison with other countries,

and just below Mauritania (54%) and the Gambia (56%). In 8 out of 10 cases, it was reported that parents

had suggested that their daughters undergo FGM/C because of religious and cultural beliefs. In urban areas,

the majority of cases of FGM/C were performed by a midwife while in rural areas, TBAs are the most

common practitioners of FGM/C. Girls from the poorest quintile were most likely to have FGM/C performed

by TBAs while those from the richest quintile most often experienced the practice at the hands of midwives

(UNICEF, 2016b). As part of the program midwives and TBAs will be pivotal in delivering program-related

activities specifically in relation to antenatal and postnatal care.

83. Observations from Ketapang showed FGC18 was commonly practiced in 3 villages, however variations

existed on who administered the procedure. Most commonly was TBAs, kampong dukun (village shaman)

or grandmothers who have decision making influence (nenek moyang). One village reported that

circumcision for females and males were held at Posyandu by Posyandu cadres whilst the other two reported

these were done at the family household.

F.2.2.2 Indigenous Peoples

84. The current understanding of the locations of Indigenous Peoples is based on database produced by

MOSA based on the following criteria: small homogenous community; remote and or limited exposure to

other communities; subsistence livelihoods; reliance on natural resources; limited access to socio-economic

and political services; clan based (Bappenas, 2013). However, this represents a small subset of communities

and the data is not up-to-date. Other possible ways to identify communities include use of maps such those

developed by the Indonesia Network for Participatory Mapping. These also have limitations.

85. Estimating the precise population size of Indigenous Peoples has been constrained by limited

population census data disaggregated based on agreeable indigeneity indicators/criteria. Civil society

groups, notably AMAN, estimates that there are roughly 50 to 70 million individuals (out of a total country’s

population of 260 million) who belong and/or identify themselves as Adat in some way or the other. While

such claims represent a major portion of the country’s population, information with regards to health or

stunting issues affecting this population category is largely unknown and would warrant further in-depth

assessments. As a result, due to the limitation of existing analytics and information, analysis presented in

the ESSA remains anecdotal and it can only be assumed that there could potentially be a large size of

18 In Ketapang FGC is performed on young girls between 0-6 months. This entails cutting the hood of the clitoris with a small and sharp blade.

Usually this blade is passed down from generation to generation creating concern over health and hygiene if the blade is rusted and unsterilized.


Indigenous populations that may be affected by stunting issues due to their level of poverty which appears

to be higher than the national average19 as well as other socio-economic factors.

86. Issues around indigenous communities’ ability to access basic services can be observed amongst remote

and isolated communities elsewhere in Indonesia. Such issues include lack of mobility, limited availability

of basic services, poor access to information, high illiteracy rates, high logistical costs, slow responses to

emergencies, etc. All of these factors combined are often attributed to poorer health outcomes amongst

remote communities, which are not unique to indigenous communities and apply to many communities that

may be considered not indigenous. A recent measles outbreak due to severe malnutrition in the Asmat

Region of Papua Province that killed 66 children (Tempo, 2018) may only reveal underlying systematic

issues in service delivery affecting remote communities.

87. Some features such as social structures and languages may likely present more constraints to effective

service delivery to indigenous communities compared to other communities. The relatively amorphous

social structure characteristics of many indigenous communities often present a challenge to external parties

attempting to engage with them, whether from the government, NGOs, private sector and other groups. In

addition, language barriers, despite prevalent use of Bahasa Indonesia as a lingua franca, tend to limit

engagement with indigenous communities, particularly the elderly and those who have not experienced

formal education. In some cases, indigenous communities choose to exclude themselves from the broader

society, such as the Baduy, Sedulur Sikep or Samin people who have resisted integration into the mainstream

society to a varying degree, and subsequently acceptance to government services. Health service providers

are often ill-prepared to respond to cultural preferences amongst these communities. For instance, in various

places in Nusa Tenggara Timur provinces, local government policies on birthing which prohibit TBAs

practicing birthing services and traditional practice of giving birth beside a fire (known as “mother roasting”)

do not address issues of rapport between health workers and local women, as well as TBAs. Such limited

engagement often results in lack of compliance and lack of trust to health service providers, who are mostly

come from outside the region (World Bank unpublished report, 2017).

88. Engagement with these communities would therefore require tailored approaches and possibly use of

local facilitators and frontline workers to foster social acceptance and rapport. For any services and

interventions planned there will be a need to understand context, accessibility, belief systems and

preferences to inform the appropriateness and uptake of the planned service or intervention. For example,

some of the indigenous communities are matriarchal which may have women and men having different

status and performing different gender roles in the area of child-care, nutrition and decision-making. Ideally

the frontline workers should be from the communities from themselves and will be equipped to ensure

participation of men, women and youth as appropriate. A Social Inclusion Specialist will form part of the

Coordinating Unit under TNP2K and will have specific experience on Indigenous Peoples, gender and

adolescent girls.

F.2.2.3 Behaviour Change

89. Key to developing effective behaviour change communication to address stunting will be understanding

how the relations of power between men and women affect household dynamics (and their respective level

of control over decision-making about resource allocation including food) and the division of labour (MCA,

2015). The MCA report suggest the need to develop behaviours will that support the following kinds of

changes and outcomes:

a. improved understanding about family nutrition, including stunting;

19 Various World Bank analyses indicate that forest-dependent communities – assumed to be largely indigenous peoples - have far higher rates of

poverty and vulnerability than mainstream Indonesians, and account for about one fifth of Indonesia’s poor. Thirty-two million people live in forest areas and, of these, 6.3 million are poor, giving a poverty rate of 20 percent compared with a national average poverty rate of around 12 percent. It

is therefore estimated that the poverty rate of many indigenous peoples in Indonesia is twice the national average (World Bank Indigenous Peoples

Study in Indonesia 2017, unpublished).


b. improved family hygiene and sanitation behaviours (including hygienic bottle feeding) to reduce

incidence of diarrhoea and enteropathy;

c. better allocation of HH budget for buying nutritious food;

d. reduction of smoking (predominantly males), particularly in the presence of children and pregnant

women;

e. effective breastfeeding, weaning, and parenting practices for boy and girl children;

f. better time use planning so that more nutritious meals can be prepared and eaten;

g. improved access to and use of quality health services for pre- and post-natal care and for delivery.

90. People’s appetite for change towards healthy behaviour varies and similarly understanding of being

sick and healthy. A Reality Check Approach (RCA, 2015) study found that baby sicknesses such as

diarrhoea, coughs, fever and running noses are often not understood as an issue and considered as normal

and part of child’s development. The study also observed that household and individual decisions around

food intakes and preferences are often informed by convenience and availability rather than what is healthy.

Sugar intake and habits of snacking and drinking instant sweet drinks are particularly prevalent among

children. The ability to buy packaged snacks is also associated with some level of social status. Under such

circumstances, availability and affordability of packaged snacks and sweet drinks at schools, combined with

the pervasiveness of packaged food advertising has exacerbated dietary patterns amongst children and

reduced demand for local food options, which could be healthier and more nutritious.

91. Understanding and practices around nutrition and child rearing are often passed down from parents and

caregivers, such as practices of early-feeding and perceptions of colostrum as ‘dirty milk’ (Mercy Corps,

2014). Public information around nutrition and sanitation is limited and often not useful. People rarely

noticed posters, which tend to tear under the elements. In the ESSA assessment and GSC mission locations,

the team observed that television has become an important means for people to get entertainment and

information. Addressing perceptions and attitudes towards nutrition would require concerted efforts,

possibly through popular mass-media in simple, aspirational, contemporary and clear rather than instructive

formats. This needs to be combined with empowering frontline health providers with accurate information,

appropriate engagement and simple communication materials to encourage change in behaviours.

Furthermore, it will also be beneficial to regulate television advertisements to ensure messages are not

distorted and/or encourage unhealthy practices.

F.2.3 Complaints and Feedback Handling

92. Learning from the GSC’s online Complaint Handling System (CHS) (http://generasi.web.id/chs),

which was re-activated in early 2017, the system has been used to handle complaints associated with the

program’s governance, in particular on aspects related to financial management, procurement and program

administration. Such an increased use of online CHS for a typical CDD program with vast coverage could

foster good governance, transparency, and responsiveness in addressing program management issues on the

ground and therefore could prevent program mismanagement from worsening. However, the use of the

system to solicit citizens’ voice around service delivery, particularly on issues related to social inclusion,

safe medical practices, and participation, would continue to be challenging. Unless there is a major case

(e.g. food poisoning), such grievances are usually low-key and do not normally attract people’s attention

and therefore are easy to be forgotten.

93. Generally, the assumed rates of grievances with regards to the use of village development funds, in

comparison to the PNPM, shows a lower rate of complaints than expected20. An earlier World Bank survey

(2016a) reported that following the field assessments, complemented with an earlier study by the World

Bank (2016) provide several explanations:

20 In comparison to the PNPM, the number of complaints estimated to the implementation of the Village Law is roughly half of the annual rate of

complaints submitted to the PNPM complaints handling system although the data is not sufficiently robust to enable firm conclusion to be drawn.

http://generasi.web.id/chs


a. Limited knowledge of entitlements and rights amongst citizens. This may be caused by lack of citizen

demand for basic services, as observed in relation to education and sanitation. Permissive attitudes with

regards to the misuse of village development funds by village officials were observed in some locations

to a varying degree (World Bank, 2016; Kompak, 2016);

b. Lack of access to grievance redress mechanisms due to geographic, financial, or information barriers as

well as legal services. In addition, the ability of village governments or program facilitators or cadres in

addressing complaints or the lack thereof also influences citizens’ trust to the existing channels;

c. Issues being perceived trivial and subjective and not worth reporting;

d. Unwillingness to articulate grievances due to fear of retribution, collective action issues and perverse

incentives. As observed during the PNPM (World Bank, 2012), villages may risk of losing project funds

in the event of corruption. For allocation of resources under village funds, there could be understanding

that little can be changed once decisions made during village deliberations (Musrenbangdes) are final;

and

e. Perceptions of lack of reliability of existing channels, particularly in circumstances where suspected

cases implicate certain individuals who are in the position of power.

f. Since the allocated budget for basic services are usually comparably smaller than other priorities (except

for infrastructure related to basic services e.g. PAUD or Posyandu building), there could possibly be

less incentives to complain.

94. Misuse of authority by district and sub-district governments is more difficult to address for two possible

reasons. First, although the overall impact of such misuse of authority may be significant, its impacts on any

particular village are likely small and therefore, represent collective action issues (World Bank’s consultant

report, 2017). Secondly, there could be low level of institutional credibility if complaints are expected to be

addressed by agencies who are themselves suspected to a complaint. That said, district-level corruption

and/or misuse of authority with regards to the provisions of basic services will not only be difficult to be

tracked due to lack of citizens’ demand to articulate complaints, particularly if it involves petty corruption,

but also difficult to be addressed.

95. Based on the institutional experience of the earlier PNPM program (World Bank, 2016), larger cases

involving individuals in the position of power such as village heads or sub-district heads, could be less

susceptible to social sanction and law enforcement due to their political and financial resources. Fear of

retaliation, particularly against whistle blowers, could also discourage people from articulating their

complaints. Only when cases exceed local norms of acceptability and there are no constraining factors and

there is a mechanism and/or channel to report cases (often motivated by political factors e.g. village head

elections), citizens are more likely to report it to the higher-level government and/or law enforcement

authorities (e.g. the police). However, as it may be expected, when cases are serious enough for people to

complain, they are more likely dealt with by law enforcement rather than government administrative

procedures.

96. A relevant question would be how to first generate a greater number of complaints so that systemic

issues can be better understood, particularly those involving the delivery of basic services using village

funds. It may be worth further exploration beyond the ESSA, but key considerations would include: a)

strengthening rights awareness and community oversight of the delivery of basic services would be

important to increase exposure of certain issues e.g. use of social media; b) it is also equally important to

ensure that there is an effective accountability mechanism to ensure village governments and/or individual

agencies are effectively pressured to address certain issues (e.g. village service audits, inspections, etc.)

97. When services are provided for free (e.g. subsidised by village funds), there is less likelihood for people

to complain about the performance of teachers and the quality and appropriateness of their services.

However, when there are extra charges required for people to able to access services, there could be a higher

interest for people to understand where their contributions are being spent and demand some level of

accountability.


98. Based on previous experiences with the GSC and PNPM, and currently with the Village Law,

complaints related to basic service availability and/or delivery or the management of the program are usually

captured through direct communication with facilitators, cadres, midwives, village heads and this largely

depends on the issues, people who get implicated in the issues, and trust-levels. This suggests that

empowering key actors to handle complaints or liaise with relevant stakeholders who may hold the authority

or possess the resources would be beneficial to enable issues to be resolved locally and quickly. At the same

time, there could be benefits to raise citizens’ awareness of various avenues/means to file complaints to

foster check and balances. Alternative mechanisms such as satisfaction surveys or strengthening

engagement on the existing grievance mechanisms may need to be considered to understand how well the

INEY PforR is meeting its desired objective.

F.2.4 Informed Decision Making and Consent

99. Ensuring informed decisions prior to administering vaccines to parents and/or caregivers would rely on

the ability and inter-personal skills. The RCA study (2015) observed that knowledge about vaccinations

varies and often little information is provided to parents and/or caregivers. Common perceptions perceive

vaccinations as mandatory, however if babies suffered fevers following vaccinations people tend to

discourage others from taking it.

100. Distribution of food supplements at Posyandu is often associated with perceptions of being poor and

mothers and/or caregivers’ lack of ability to provide for their children. Praise for weight gain at the Posyandu

may also encourage people to feed their babies with solid foods early and tend to incriminate those with

skinnier children (RCA 2015). Alternatives can be sought by empowering frontline health workers to

provide culturally and socially sensitive services that avoid stigma, including tailoring services to specific

needs (e.g. home-based care). Providing trusted cadres and other carers, such as TBAs with appropriate

incentives and support should also be built into the overall basic health service system.


G ENVIRONMENTAL AND SOCIAL ACTIONS.

G.1 Environmental Measures

101. Based on capacity assessment mapped out by the ESSA team (see Annex 5) and consultation workshop

was conducted on April 9, 2018 (Annex 3), strengthening institutional capacity ranges from providing

relevant training to implement policies and technical guidelines to equipping related staffs with practical

tools and equipment on safe-handling of pharmaceutical waste in general and particularly waste disposal

system are needed.

Table 6: Environmental Measures to Strengthen Institutional Capacity

Institutions Identified Capacity Building

National Level

Ministry of Health (MOH), including:

- Directorate of Primary Care

- Directorate General of Community

Health

- Directorate General of Public

Pharmaceutical and Health Supplies

MOH to ensure adequate budget allocation and resource planning for

the implementation of the following policy and regulations that relate

to the delivery of the nutrition-specific interventions:

- The MOH Guidelines (2016) regarding: The Integrated

Management for Vitamin A Supplement.

- MOH Regulation No. 12 Year 2017 on The Implementation of

Immunizations.

- MOH Regulation No. 27 Year 2017 on the Guidelines for

Prevention and Control of Infection in Health Care Facility.

Ministry of Public Works (MPWH) &

MOH, MOV

Although INEY does not directly include MPWH activities in the

program boundaries, the Program, in its focus on appropriate use of

water and sanitation facilities, MPWH in cooperation with MOH and

MOV should pay attention to water resource management so as to

ensure INEY’s target beneficiaries have sustainable access to safe

drinking water and sanitation facilities.

Province/District/Sub-district and Village Levels:

DHOs, Pharmaceutical Facility at the

provincial and district levels.

Sub-district:

Puskesmas staff

Village:

Posyandu

Training on waste reduction and handling of pharmaceutical waste,

special attention on procedures, techniques and mechanism in

emergency situations. Emergency situations range from the lack of

disposal facility to inadequate provision of the available transporter

company. In specific circumstances, burial technique is allowed for

Puskesmas that are very remote and has no access to a proper

transportation system

102. Measures to strengthen system performance for environmental management are aimed to generate the

desired environmental effects such as: (i) providing technical guidelines for effective implementation of

environmental mitigation measures such as promoting water resource management; and (ii) applying

standard good practices. These measures aim to strengthen institutional capacity as well as to generate the

desired environmental effects


Table 7: Environmental Measures to Generate the Desired Environmental Effects

Objectives Measures

Strengthen institutional

capacity and compliance

regarding safe handling

and disposal of

medical/pharmaceutical

waste.

Ensuring adequate capacity of safe handling and disposal of medical/

pharmaceutical waste in PHC is the focus of other relevant GOI program, e.g., I-

SPHERE, DAK Penugasan Kesehatan Non Fisik (Coordination Forum and BOK).

It is therefore recommended that INEY work with I-SPHERE in improving

management of medical/pharmaceutical waste, including through facilitate

coordination among relevant agencies at the district level (involving HDW

facilitarors, mid wives etc.).

Monitoring system for waste disposal by appropriate authority should be made

available at the district level to ensure compliance.

Strengthen institutional

capacity and compliance

regarding provision of

safe water supply and

sanitation

As per standard practice, hand washing facilities should be available at all latrines

and in proper working conditions.

Ensuring that new sanitation installations have the minimum safe distance between

latrines and water sources should be maintained as per standard practice. For

existing facilities where the standards have not been made, the water sources should

be continuously screened for bacterial contamination and adequate water treatment

(filtering, chlorination) should be adopted where water have been found to be

bacteriologically contaminated.

Budgetary provisions for water quality monitoring should be made available at the

district level.

G.2 Social Measures

103. Village systems and participation: Potential for inequality and conflict may stem from real or

perceived differences in how the program’s benefits are distributed. There is also a potential for elite capture.

The use of HDW and social mapping exercise, if well trained, should ensure the participation of all groups

within the village.

104. Access and Inclusion: The INEY PforR is expected to build on lessons learnt to mainstream gender

into its planned interventions and these are addressed as part of the technical assessment. It is expected that

the program will through the social mapping and use of HDW program ensure that interventions take into

account local context, culture, belief and value systems of Indigenous Peoples as well as of those groups

identified as vulnerable. A Social Inclusion Specialist will form part of the Delivery Unit under TNP2K and

will have specific experience on Indigenous Peoples, gender and adolescent girls.

a. Behaviour Change: To affect the behaviour change needed to address stunting, strategies will require

contextualising knowledge, skills and attitudes of men and women, which in turn are shaped by societal

and gender norms based on customary, indigenous, personal and formal laws, customs and practices.

b. Gender, Nutrition and Stunting: To effectively address child stunting and malnutrition, the review of

literature, including evidence from Indonesia, suggests the need to combine nutrition‐specific

interventions with measures for empowerment of women and men’s participation. Improvement in

nutrition of and uptake of health services by women and access to water and sanitation will not be

sufficient. Prevention of early age marriage and conception, education, increasing women’s decision-

making power over resources, creating a supporting environment, reduction of women’s workloads, and

addressing gender based violence are a few areas that deserve attention. It will be important to ensure

that appropriate foods are provided as part of the nutritional package and that take into account

nutritional value, cultural preferences, and time and resources to prepare. Indigenous Peoples and

indigenous women will have very specific needs and matriarchal communities may present differing


gendered perspectives which all will need to be understood. A range of measures to increase men’s

participation and for effectively reaching adolescent girls and women prior to as well as during and after

pregnancy should be used to accelerate reduction in stunting.

105. Complaint and Feedback Handling: There is no one system and the systems that exist are not

equipped to capture feedback and complaints across the planned interventions. The Village Convergence

Scorecard is proposed as the system though which feedback and complaints could be identified, handled

and monitored.

106. Informed Decision Making and Consent: While systems exist to secure consent for vaccination,

blood testing and surveillance, there is insufficient awareness over rights and the practice of consent is varied

dependent on the capacity of the frontline health workers. Capacity could be strengthened through training

and ensuring that the information, education and communication activities associates with vaccination

campaigns inform people of their rights.


Table 8: Proposed Environmental and Social Actions.

Action Description DLI Responsibility Recurrent Frequency Due

date

Completion Measurement

SoVP prepares Program Operations Manual (POM) in collaboration with

Bappenas, MoF and all implementing agencies covering program planning,

budgeting, monitoring, reporting and evaluation. It will also include

procedures for coordinating with other programs (e.g., PAMSIMAS, I-

SPHERE) on environmental issues.

N/A SoVP No 31

Jul-

2018

Program Steering Committee

approves POM for

dissemination and operational

reference

MOV to establish a mechanism to capture feedback, concerns and

complaints as part of the Village Convergence Scorecard.

DLI 9 & 10 MOV Yes Continuous 31-

Jul-

2018

Completed scorecards and

system operationalised for

addressing feedback and

grievances.

SoVP establishes a Program Support Unit that a social inclusion specialist

with experience with Indigenous Peoples, gender and adolescent girls.

TORs of all staff will include requirements to pay appropriate attention to

environment and social issues in their tasks.

Program

Management

SOVP Yes Continuous 31-

Jul-

2018

Specialist recruited and

retained during the life of the

Program.

MOH conducts a review of knowledge, behaviours and specific

requirements of Indigenous Peoples as part of preparing Gerakan

Masyarakat (Germas) or Community Action Guidelines and modules with

training materials for local BCC/IPC programming.

6 MOH No 31-

Jul-

2018

Review conducted and

consulted with key

stakeholders as part of

preparation of Germas

Guidelines.

Modules with training modules

prepared and records of

training undertaken.

MOHA to include environment specialist in provincial TA pool structure to

advise districts on environment issues (e.g., medical waste,

watersheds/water resource management).

N/A MOHA No 31

Dec

2018

Specialist in place


H ENVIRONMENTAL AND SOCIAL RISK RATING

107. Based on the assessment findings and draft mitigation and improvement measures the overall

environmental and social risk is considered to be moderate.

108. Overall, the risk assessment and screening suggests that the environmental impact of the program is

likely to be positive; delivering a number of environmental benefits, such as access to improved drinking

water supply, access to better sanitation facilities and improved sanitation conditions. Main environmental

issues and risks are expected to be moderate and relate to safe handling of pharmaceutical waste and disposal

systems managed by Posyandu and Puskesmas, quality and quantity (continuity) aspects of water supply

provision and unsafe construction practices for sanitation facilities. Measures to strengthen system

performance for environmental management include: (i) strengthening relevant institutions through the

provision of practical knowledge and resources that ranges from providing relevant training to implement

policies and technical guidelines to equipping related staffs with practical tools and equipment on safe-

handling and disposal system of pharmaceutical waste; and (ii) generating the desired environmental effects

such as promoting water resource management, applying standard good practices, allocating more

experienced facilitators and consultants in providing technical support and supervision for the provision of

basic water and sanitary services, providing technical guidelines for effective implementation of

environmental mitigation measures, and closely collaborating between local governments and other relevant

stakeholders such as private sector, university, association and NGOs.

109. The INEY PforR with its focus on a 100 priority districts to address high levels of and the rising

inequality in stunting in Indonesia has overall beneficial social outcomes. There are currently no

infrastructure related investments planned. Adverse impacts are not anticipated in relation to natural

resources, or to assets or livelihoods of people based on the activities supported by the INEY PforR. Social

effects will mainly arise from activities associated with RA 4 on prioritising convergence of village service

delivery. There will be some effects also associated with RA 2 (strengthen delivery of sector programs and

RA 3 (strengthen convergence of district activities). The effects considered as part of the ESSA focus on

households’ and groups’ need to obtain services in an accessible, safe and inclusive manner. The ESSA also

considers whether the delivery of educational, behavioural change communication, information on nutrition

specific interventions, particularly health services consider local context (literacy, language, and cultural

aspects of the beneficiaries). Potential inequality and conflict may stem from real or perceived differences

in how the program’s benefits are distributed. To address these risks, it is important to make available an

accessible process for raising complaints and concerns and ensuring they are addressed appropriately. If

village level systems are inclusive and participatory and managed well the most vulnerable stand to benefit.

In light of this, it is expected that Indigenous Peoples, if present in the targeted communities, should benefit

from the program and vulnerable groups should not be adversely impacted. Poorer families, lesser educated

mothers, young mothers, older mothers, unmarried mothers, single parent families or child headed

households, and parents with HIV status are likely to be the most vulnerable. Based on the above assessment,

the program is expected to contribute to addressing equity issues the risk has been rated as low.


I INPUTS TO THE PROGRAM IMPLEMENTATION SUPPORT PLAN

I.1 Environment

110. A workshop with key stakeholders has been conducted to discuss input for required action plans.

During implementation support stage, the program will work together with MOH to develop a waste

reduction work plan which will include the provision of capacity building, with a particular emphasis on

issues related to transportation of medical waste and specific training on medical waste treatment including

burial technique for Posyandu in remote locations. At the Mid Term Review stage, the program will review

the applicability of the proposed action items and the work plan; identify the challenges and opportunities;

and make necessary corrective actions and adjustment for the next term of project implementation.

I.2 Social

111. A consultation workshop on the draft ESSA was undertaken on April 09, 2018 with representatives

from with representatives from central ministries, including MOHA, MOEF, MOH as well as

representatives from Central Maluku District, Gorontalo District of Gorontalo Province, Cianjur District of

West-Java, Central Lombok District of NTB and Ketapang District of West Kalimantan. The findings from

the workshop suggested the social effects and actions considered as part of the social systems assessment

wereappropriate. Amont other points the following issues were raised at the workshop:

a. Strengthening of capacity of cadres, revisiting incentives, extra resouces, increased collaboration of

PAUD, integrated guidelines for education, insufficient infrastructure, sustainability of services;

b. Accessibility remains an issue particularly for remote communities, frontline health worker distribution,

c. Interventions specifically designed for men and outreach to men to enable their participation;

d. Outreach to adolescent girls requires a tailored approach, need for parenting education for youth,

e. PAUD services cater for the age 2 and above children but the Program is aimed households with 0-2

years;

f. District government’s ability to adjust fiscal transfer from central government to address localised and

changing needs, national planning not synchronised with district planning;

g. Socio-cultural factors prevent access to services including vaccinations;

h. Smoking habits are an issue;

i. Correct targeting of beneficiaries and inclusive engagement by facilitators; and

j. Further understanding is needed of quality of services and perceptions of those services from end

beneficiaries.

112. To address the challenges of the numerous systems for managing feedback and complaints, it is

recommended as part of the action plan to institutionalise the feedback and complaints handling through the

Village Scorecard. This will require the following:

a. Engaging with beneficiaries on the feedback and complaints mechanism;

b. Capacity building of frontline service providers particularly HDW and Cadres including on informed

consultation and use of the scorecard; and

c. Supporting district and village governments to operationalise the mechanism in the scorecard to better

inform planning and monitoring of service delivery at the village and district levels.

113. To ensure interventions take into account local context and address social inclusion (gender,

vulnerability, early marriage, child pregnancy and Indigenous Peoples), it has been recommended that a

specialist is recruited and retained as part of the Program Support Unit at the SOVP.

a. To support the recruitment of an appropriate specialist, a TOR will need to be developed and support

may need to be provided to SOVP on the development of the TOR and the recruitment and selections

process;


b. To support the specialist and based on the reviews of district capacity to deliver required interventions

that take in local context including barriers to social inclusion, develop a training plan to support on

capacity building and technical assistance needs; and

c. Undertake periodic review with the specialist as part of the capacity building.

114. The program action plan as part of the Program Appraisal Document has addressed specific

inequalities with regards to gender and that have been informed by the analysis undertaken as part of social

systems assessment of the ESSA. These actions include:

a. a review of knowledge and behaviours of men’s caregiving is undertaken as part of preparing Germas

Guidelines and modules with training materials for local BCC/IPC programming;

b. women's empowerment and men's parenting roles are integrated in parent modules in ECED

Professional Development Program;

c. module is developed and included in HDW training and socialization materials on women’s

empowerment and role of men in childcaring, and on use of quarterly stunting forums to communicate

on the benefits of delaying early marriage and pregnancy; and

d. module is developed and included on early marriage and pregnancy in training materials for

implementing the Germas Guidelines for local BCC/IPC programming.


J BIBLIOGRAPHY

Anderson, Ian; Meliala, Andreasta; Marzoeki, Puti; Pambudi, Eko. (2014). The production, distribution,

and performance of physicians, nurses, and midwives in Indonesia: an update (English). Health,

nutrition, and population (HNP) discussion paper. Washington, DC: World Bank Group.

http://documents.worldbank.org/curated/en/912471468254690409/The-production-distribution-and-

performance-of-physicians-nurses-and-midwives-in-Indonesia-an-update

Bah, Adama, Fransiska E. Mardiananingsih, and Laura Wijaya (2014). An Evaluation of the Use of the

Unified Database for Social Protection Programmes by Local Governments in Indonesia, TNP2K

Working Paper 6-2014. Jakarta: Tim Nasional Percepatan Penanggulangan Kemiskinan (TNP2K).

Butt, Leslie (2005). ‘Lipstick Girls’ and ‘Fallen Women’: AIDS and Conspiratorial Thinking in Papua,

Indonesia. Cultural Anthropology 20, no. 3: 412–442.

Government of Indonesia (2014). Village Law No. 6 of 2014 on Villages. Jakarta: Government of the

Republic of Indonesia.

House of Representatives (2009). Law No. 32 of 2009 on Environmental Protection and Management.

Government of Republic of Indonesia.

House of Representatives (2009). Law No. 36 of Year 2009 on Health. Jakarta: Government of Republic

of Indonesia.

Human Rights Watch (2017). World Report 2017: Events of 2016. USA. Human Rights Watch

National Planning Agency (2013). Masyarakat Adat di Indonesia: Menuju Perlindungan Sosial yang

Inklusif . Jakarta. National Planning Agency

Mahendradhata, Yodi et al. (2017). The Republic of Indonesia Health System Review. Asia Pacific

Observatory on Health Systems and Policies vol. 7 No.1 2017.

MCA (2015). Indonesia Compact: Updated Social and Gender Integration Plan. Jakarta, Indonesia.

MCA Indonesia.

Ministry of Education and Culture (2014), MoEC Regulation on Early Childhood Education No.

137/2014. Jakarta: Government of Indonesia.

Ministry of Education and Culture (2014). Ministerial Regulation No 137 of 2014 on National Standards

of Early Childhood Education. Jakarta: Government of Republic of Indonesia.

Ministry of Environment (1995). Decree on Environmental Agency (Kepbappedal) No 03/Bapedal/09/ of

Year 1995 on Emission standards from Incinerators. Jakarta: Government of the Republic of Indonesia.

Ministry of Environment (1995). Ministerial Decree No 58 of Year 1995 on Hospital Effluent Discharge

Standard. Jakarta: Government of Republic of Indonesia.

Ministry of Environment and Forestry (2001). Government Regulation No. 74 of Year 2001 on

Management of Hazardous Material. Jakarta: Government of Republic of Indonesia.

Ministry of Environment and Forestry (2012). Government Regulation No.27 of Year 2012 on

Environmental Permit. Jakarta: Government of Republic of Indonesia.

Ministry of Environment and Forestry (2014). Government Regulation No. 101 of 2014 on Management

of Toxic and Hazardous Waste. Jakarta: Government of the Republic of Indonesia.

http://documents.worldbank.org/curated/en/912471468254690409/The-production-distribution-and-performance-of-physicians-nurses-and-midwives-in-Indonesia-an-update

http://documents.worldbank.org/curated/en/912471468254690409/The-production-distribution-and-performance-of-physicians-nurses-and-midwives-in-Indonesia-an-update


Ministry of Environment and Forestry (2015). Ministerial Decree No 56 of Year 2015 on Procedures and

Technical Requirement of Hazardous Waste Management from Health Care Facilities. Jakarta:

Government of the Republic of Indonesia.

Ministry of Environment. Ministerial Decree No. 16 of Year 2012 on Guidelines for Preparation of

Environmental Documents (AMDAL). Jakarta: Government of Republic of Indonesia.

Government of Indonesia (1996). Government Regulation No 32 of 1996 on Health Workers. Jakarta:

Government of Republic of Indonesia.

Ministry of Health (2008). Ministry of Health Regulation No 290/PER/III of 2008 on Informed Consent.

Jakarta: Government of Republic of Indonesia.

Ministry of Health (2010). “Ministry of Health Regulation No. 1144/MENKES/PER/VIII/2010 on

Organization and Administration of the Ministry of Health”. Jakarta: Government of Indonesia.

Ministry of Health (2014). Ministerial Regulation No. 75 Year 2014 on Puskesmas. Jakarta: Government

of Republic of Indonesia.

Ministry of Health (2015). Ministerial Regulation No. 46 of 2015 on Primary Health Facility

Accreditation. Jakarta: Government of Indonesia.

Ministry of Health (2017). Ministerial Regulation No 12 Year 2017 on Guidelines on the Administration

of Vaccines. Jakarta: Government of Indonesia.

Plan International (2015). Getting the Evidence: Asia Child Marriage Initiative.

Reality Check Approach + Project Team (2015). “We Are Healthy, Why Change?”. Jakarta: Palladium.

Semba et al (2006). Paternal Smoking and Increased Risk of Infant and Under-5 Child Mortality in

Indonesia. American Journal of Public Health. USA.

SMERU (2015), “Policy Brief on the Role of Sub-District Heads”. Jakarta: SMERU Research Institute.

The Reality Check+ Team, The Palladium Group (2016). Local Perspectives and Experiences of the

Village Law in Indonesia, Jakarta: Reality Check Approach (RCA) in collaboration with Kolaborasi

Masyarakat dan Pelayanan untuk Kesejahteraan (KOMPAK).

UNICEF (2015). Cost of Inaction: Child and Adolescent Marriage in Indonesia. Jakarta, Indonesia.

UNICEF.

UNICEF (2016). Child Marriage in Indonesia: Progress on Pause. Jakarta, Indonesia. UNICEF.

UNICEF (2016b). Statistical Profile on Female Genital Mutilation/Cutting. Jakarta, Indonesia. UNICEF.

UNICEF, LSTM (2011). Gender Influences on Child Survival, Health and Nutrition.. New York.

UNICEF.

World Bank (2012). Governance Review of PNPM Rural: Community Level Analysis, World Bank,

Jakarta.

World Bank (2016a). Village Law Debottlenecking Diagnostic and Needs Assessment: Descriptive Report

April 2016, Jakarta: World Bank and the Coordinating Ministry of Human Development and Culture by

JRI Research.

World Bank (2017). Draft Report on the Quantitative Service Delivery Survey 2016 (unpublished).

Jakarta: World Bank.


World Bank (2017). Increasing Inclusiveness: Indigenous Peoples and Sustainable Local Development

(unpublished). Jakarta: World Bank.

World Bank Consultant (2016). Back to Office Report: Preliminary Assessment of Village Law

Complaints Handling and Dispute Resolution Capacity at the District Level and Below in Central Java

and West Sulawesi, Jakarta: unpublished report.


ANNEXES


Annex 1: Program Results Framework

RESULT_FRAME_T BL_ PD O

PDO Indicators by Objectives / Outcomes DLI CRI

Unit of Measure

Baseline Intermediate Targets (IT) End Target

Y1 Y2 Y3

Results Area 1: Strengthen national leadership

Increased public commitment of Priority District leaders to accelerate stunting reduction

DLI 1 Number 0.00 60.00 96.00 234.00 308.00

Results Area 2: Strengthen delivery of sector programs

Priority Districts implement locally-adapted interpersonal communication (IPC) activities

DLI 6 Number 0.00 80.00 128.00 312.00 380.00

Results Area 3: Strengthen convergence of district activities

Increased performance of districts in delivery of priority nutrition interventions to 1,000-day households

DLI 8 Percentage 55.00 69.00 77.00

Consumption of IFA supplements during pregnancy 32.70 40.00 50.00 60.00

Results Area 4: Converge village service delivery

Village-level convergence of nutrition interventions on 1,000-day households.

DLI 10 Percentage 5.00 25.00 45.00

.


.

RESULT_FRAME_T BL_ IO

Intermediate Results Indicators by Results Areas DLI CRI

Unit of Measure

Baseline Intermediate Targets (IT) End Target

Y1 Y2 Y3

Results Area 1: Strengthen national leadership

Improved tracking and performance evaluation of national spending on priority nutrition interventions

DLI 2 Text

Ad hoc performance reports and budget reviews

Tagging and tracking systems developed

Six monthly performance report issued

Performance report issued and budget reviewed

Performance report issued and budget reviewed

Increased transparency and timely publication of annual district stunting rates

DLI 3 Text

Low data transparency and 4-5 year gap between surveys

Publication district stunting rates by July

Publication of district stunting rates by July

Publication of district stunting rates by July

Results Area 2: Strengthen delivery of sector programs

Priority Districts have delivered nutrition-sensitive professional development program for ECED Teachers

DLI 4 Number 0.00 0.00 100.00 200.00 300.00

Beneficiaries receiving food assistance program (BNPT) in Priority Districts

DLI 5 Percentage 0.00 60.00 90.00 90.00

E-warungs in Priority Districts disbursing BPNT benefits have all eligible food items available including additional nutritional items.

DLI 5 Percentage 0.00 0.00 0.00 50.00 80.00

Incorporation of women’s empowerment programs in NatStrat Stunting list of priority nutrition-sensitive internventions

Tex Text

Women’s empowerment programs not included

Women’s empowerment programs included

Results Area 3: Strengthen convergence of district activities


Increased predictability and results-orientation of fiscal transfers that support convergence

DLI 8 Text

Fragmented guidelines and performance assessment

Convergence program guidelines published

Performance assessment conducted and published



Results Area 4: Converge village service delivery

Villages empowered to identify 1,000-day households and converge intervention delivery

DLI 9 Number 0.00 96.00 234.00 308.00

Men’s participation in community nutrition counselling Percentage 20.00 30.00 30.00 40.00


Annex 2: Environmental and Social Risks and Impacts Screening

Five Priority Service

Packages E&S Issues and Risks

Significance

(Low,

Moderate,

High)

Capacity to be Assessed Systems to Manage the Risks Assessment of Gaps

Stakeholders to

be consulted incl.

Affected Parties

1.b. Taking iron

tablets during

pregnancy

Environment:

Public health issues related to

handling, distribution and

storage of oversupplied tablets.

Low (social)

to Moderate

Trained/qualified staff to

implement the national

guidelines, government

regulations and

procedures for handling

and distribution of

supplements

National guidelines on handling,

distribution and storage of

supplements (roles and

responsibilities and oversight)

Posyandu management system

overall (including manuals for

midwives and cadres with

regards to community

engagement, consent, and

grievance handling, or the lack

thereof)

Level of capacity to

implement provision of the

legal, policy and regulatory

framework

Availability of budget

provision for training and

supervision

Level of monitoring and

supervision on the

implementation of the

national guidelines.

National: MOH-

DepKes

(Directorate of

Primary Care)

District and

Village: District

Health Offices

(DHOs),

Puskesmas staffs,

and frontline

health workers

(midwives and

Posyandu cadres),

community

members

1.a. Four prenatal

care visits for

pregnant women

1.b. Taking iron

tablets during

pregnancy

1.c. Growth

monitoring

1.d. Three postnatal

care visits

Social: Access to services (be

framed within the overall access

to healthcare), information, and

consent needs to be sensitive to

social, religious, cultural and

other beliefs and values.

1.e. Complete

childhood

immunizations

Environment:

Manifest management: the

supply, distribution and storage

of vaccines, including the

availability of Safety Box, Cold

Chain, vaccine refrigerator, cold

box (for vaccine transportation),

etc.

Handling and disposal of used

syringes

Handling and disposal of

pharmaceutical waste

(expired/damaged/unused

vaccines).

Handling and disposal of

vaccine vial (empty vial)

Low (social)

to Moderate

Trained/qualified staff to

implement the national

guidelines, government

regulations and

procedures for handling

and distribution of

supplements, community

engagement

(consultation, provision

of information, as well as

exercise of consent),

access to grievance

redress mechanisms

1. Government regulation (PMK

No. 12/2017) Regarding the

implementation of

immunizations which include

provisions for the supply,

distribution and storage of

vaccines.

2. Procedures for handling and

disposal of medical waste

including: used syringes,

expired/damaged/unused

vaccines, and empty vaccine

vial. (reference: 1. Minister

(MOEF) Regulation no 56 year

2015 on procedure and technical

requirement for management of

hazardous waste from health

service facility) ; 2. Minister of

Health regulation no 27 year

2017 on Guidelines for

Level of capacity to

implement provision of the

legal, policy and regulatory

framework

Availability of budget

provision for training and

supervision

Equipment/ infrastructure

needed for safe-handling of

medical waste and storage of

vaccines

- Level of monitoring and

supervision on the

implementation of the

national guidelines.

- Community engagement and

consent practices, as well as

National:

MOH/DepKes

(Directorate of

Primary Care)

District and

Village: DHOs,

Puskesmas staffs,

frontline

healthworkers

(midwives and

Posyandu cadres),

community

members

Social: Access to immunization

services (to be framed within the




Significance

(Low,

Moderate,

High)


Stakeholders to

be consulted incl.

Affected Parties

overall access to health

services), consent and access to

information need to be sensitive

to social, religious, cultural and

other beliefs and values.

prevention and control infection

in health service facility)

3. Posyandu management system

overall (including manuals for

midwives and cadres with

regards to community

engagement, consent, and

grievance handling, or the lack

thereof)

handling of

complaints/grievances

2. Nutrition, Hygiene

and Parent

Counselling

(including 2.a and

2.b)

Social: Access to counselling,

cultural appropriateness of

counselling delivery and social

acceptability, community

engagement.

Low Puskesmas’ capacity

building and oversight

systems to frontline

healthcare providers who

deliver counselling

services (midwives,

cadres, and Kesling staff)

Communication and community

engagement systems

Community engagement,

behavioural change

communication, and consent

practices

MOH (Directorate

Kesmas),

District and

Village: District

Health Offices

(DHOs),

Puskesmas staffs,

and frontline

health workers

(midwives and

Posyandu cadres),

community

members

3.a. Access to

improved drinking

water (this may be

delinked with

PAMSIMAS)

Environment:

- Water quality: water

testing/sampling before using a

new water source. Need to apply

parameters prescribed by MOH.

- Apply safe distance (minimum

of 10m) from toilets and septic

tanks.

- Water collection and

distribution.

Low (social)

to Moderate

Implementation of the

technical guidelines. Can

be assessed through

lessons learned from

PAMSIMAS and PNPM

Rural.

Capacity of BPSAM staff

or facilitators in

understanding basic

water treatment

technology such as

filtration, Fe and Mn,

treatment, peat water etc.

Existing technical

guidelines/code of practice for

the construction of community

level water supply facility

(developed through PAMSIMAS

and PNPM Rural)

MOH guidelines for water

quality for drinking water

Village law guidelines

(including village deliberation)

Gaps between the technical

guidelines and the quality of

construction, land donation

practices, as well as selection

of beneficiaries (at the

village level through village

deliberation). This can be

assessed through lessons

learned from PAMSIMAS

and PNPM Rural as well as

village law implementation

Gaps between the initial

coverage of the system vs the

National: MPWH

and MOH

District/Village:

Staff at relevant

Dinas, village

governments and

BPPSPAM, and

community

members

BPSAM of visited

village or

BUMdes who Social: Access to water for all

and includes participation of




Significance

(Low,

Moderate,

High)


Stakeholders to

be consulted incl.

Affected Parties

girls, women and vulnerable

groups in provisioning.

Continuity of monthly fee from

the water users (PAMSIMAS

participants).

Adequate funds/money for

purchasing spare parts if break

down

System to maintain the

watershed or the water recharge

area intact to ensure the

sustainability and continuity of

the water source

current application

(decreased).

Gaps between the cost for

operations vs the “iuran” or

fee from beneficiaries.

manage the

PAMSIMAS

3.b. Access to

improved sanitation

facility (STBM –

Community total led

sanitation)

Environment:

- Location/site selection of

sanitation facilities: apply safe

distance (minimum of 10m,

downstream) from water

sources.

- Quality of sanitation facilities:

construction and provisions of

water supply to toilets.

Low (social)

to Moderate

Implementation of the

technical guidelines. Can

be assessed through

lessons learned from

PAMSIMAS and PNPM

Rural as improvement

recommendations for

their program.

Existing technical

guidelines/code of practice for

the construction of community

level sanitation facilities

(developed through PAMSIMAS

and PNPM Rural), facilitation

skills and community

engagement

Gaps between the technical

guidelines and the quality of

construction. This can be

assessed through lessons

learned from PAMSIMAS

and PNPM Rural, level of

participation and inclusion

for community mobilization

and facilitation

National:

MPWHMPWH

and MOH

District/Village:

DHO, DPMD,

Staff at relevant

Dinas, village

governments,

CLTS facilitators,

community

members

Social: Needs to take into

account the needs of girls and

women. Since the model

adopted is Community Led

Total Sanitation (CLTS) risks

are low. Facilitation skills could

be an important determinant for

social outcomes.

5. a. Participation in

PAUD for early

learning/stimulation

Environment:

Hand-washing program will

benefit the early years learning

towards improved personal

hygiene for the school children

Low (social)

to Moderate

Provision of the staff who

are trained to deliver the

curriculum and capacity

building and incentive

mechanisms available

Transition mechanisms

(participation in musdes

Provisions of the

program/subject within the

existing PAUD curriculum,

PAUD manuals

Budget allocation in RKPDes

and APBDes

National curriculum and

budget to implement,

implementation practices

with regards to social

inclusion and

appropriateness of services

National:

MOEC

District: District

Education

Agencies, GSC

facilitators

Social: Access to PAUD

services for all, including poor

and vulnerable families




Significance

(Low,

Moderate,

High)


Stakeholders to

be consulted incl.

Affected Parties

previously supported by GSC,

appropriateness of service

delivery.

and musdun to vocalise

these) implemented to

ensure vulnerable and

poor families continue to

be supported

PAUD cadres,

community

members

5.b. Introducing

Parenting Education

through PAUD

teachers

Social: Access to marginalized

and vulnerable groups that do

not reside in a village/and

mothers and fathers that do not

place their children in

TK/PAUD. Men should also be

involved. Potential for reaching

out to adolescent girls and boys

should be explored.

Low Capacity of PAUD staff

to provide these extra

services re incentives and

willingness

Provisions of the

program/subject within the

existing PAUD curriculum,

PAUD manuals

Effective socialization and

appropriate compensation for

PAUD teachers to do extra

outreach

Identifying how many villages

have included this module into

their RKPDes (Village

Development Plan)

This program is targeted

towards mothers of TK/non-

PAUD children therefore it

will be extra outreach for

them to engage them,

incentives may need to

compensate for this

Gaps:

- Incentives

- Monitoring systems

- Budgeting

It won’t be launched until

2019 because the Village

Development Planning

session for 2018 has already

taken place

National:, MOEC,

Directorate ECED

Teacher Training

District: District

Education

Agencies

Kepala desa,

PAUD cadres,

community

members


Annex 3: Stakeholder Engagement

Table 9: Stakeholders consulted in the preparation of the INEY Program.

Administrative Level Stakeholders

National

Bappenas - Deputy for Human Development

- Directorate for Health and Community Nutrition

- Deputy for Developing Financing

- Deputy for Regional Development

Coordinating Ministry for Human

Development and Culture

- Directorate for Health

Ministry of Education and Culture - Directorate General for Early Childhood Education Development

(ECED/PAUD)

- Directorate of Parenting

- Directorate for Teachers

Ministry of Finance - Directorate General of Budget

- Information Systems and Technology Treasury Division

- Directorate General of Budget Financing and Risk Management

- Directorate General of Fiscal Balance

- Fiscal Policy Division

- Directorate for APBN Preparation

Ministry of Health - Health promotion and Community Empowerment Division

- Primary Healthcare Division

- Community Nutrition Division

- Planning and Budgeting Division

- Directorate of Family Health

- Human Resources Development and Empowerment Division

- Directorate of Community Nutrition

- Environmental Health Division

- Bureau of Planning

- RISKESDAS

Ministry of Public Works and Housing - Environmental Health Development Division

- Water Supply Development Division

- Integrated Settlements Infrastructure Division

Ministry of Social Affairs - Directorate General of Handling the Underprivileged

- Working Group Monitoring and Evaluation, TNP2K

Ministry of Villages - Directorate General of Village Development and Community

Empowerment

- Directorate for Basic Social Services

Ministry of Environment and Forestry - Directorate for Performance Assessment of Management of

Waste (Hazardous and Non-hazardous)

Secretariat of Vice President - Deputy for Human Development and Equality

- TN2PK Secretariat

Development Partners - DFAT

- UNICEF

- MCA-I

Private Sector - Indofood

- SUN Business Network

North Sulawesi Province

Provincial Government - Secretary of Department of Community and Village

Empowerment GSC Provincial Coordinator



District Government of Talaud - BAPPEDA

- Head of Village Community Empowerment and Development

Agency

- Health Agency

- Education Agency

- GSC facilitators

- GSC treasurer

Village Government, civil society, service

providers, and affected communities:

Melonguane, Kabaruan, Desa Bowone

Damau, Desa Damau Karakelong, Desa

Bantik Karakelong, Desa Ensem Rainis,

Desa Rainis

- Mothers

- Pregnant women

- Puskesmas doctor

- Head of Puskesmas

- Puskesmas/Posyandu cadres

- PAUD operators

- PAUD staff

- PAUD cadres

Gorontalo Province

Provincial Government - Provincial GSC Coordinator

- Provincial PAMSIMAS Coordinator

District Government of Gorontalo - Secretary of Department of Community and Village

Empowerment Agency

- BAPPEDA

- Village Community Empowerment and Development Agency

- District Health Office

- Health Agency

- Head of Community Health Division

- GSC District Secretary Office

- GSC District

- Public Works Agency

- PAMSIMAS Team, Local Government Specialist, Water and

Sanitation Specialist, District Coordinator

- Head of Environmental Health

- Head of Disease Control and Environmental Health Division

- District Housing/Human Settlement Office

- Agency for Implementation of Water Supply System



Pulubala; Desa Bakti Kec Pulubala,

Desa Kayu Merah and Desa Liyodu Kec

Bongomeme,

Desa Tabumela Kec Tilago

- Head of village

- Village committee

- Mothers

- Fathers

- Village midwives

- Nutritionist

- Cadres

West Nusa Tenggara Province

Provincial Government - Procurement Unit

- State Treasury Regional Office

- Head of Bank Section

District Government of Lombok Tengah - BAPPEDA

- Head of Social and Cultural Affairs

- Head of Education

- Head of Health

- Head of Monitoring and Evaluation

- Head of Planning



- District Finance and Asset Management Office – Head of Budget

Division, Staff of Treasure Division, Head of Treasury Division

- Health Agency

- Head of Community Health Division


- Head of Disease Control and Environmental Health Division

- Agency for Implementing Water Supply Systems

- PAMSIMAS District Team

- PAMSIMAS facilitators

- GSC District Team

- HDW facilitators

- GSC facilitators



Praya Barat; Desa Mekar Sari

- Village Head

- Village Committee

- Head of Dusun

- Community Members

- Head of Puskesmas

- Nutritionist

- Puskesmas Treasurer

West Java Province

Provincial Government

District Government of Cianjur - BAPPEDA

- Agency for Cultural and Social Affairs

- Planning Agency

- Health Agency

- Head of Public Health Division

- Bupati

- Health Agency

- Health Promotion

- Head of Family Health and Nutrition

- Head of Pharmacy Agency

- Staff of Family Health and Nutrition

- Head of Human Resources

- Head of Field and Disease Control


- Head of Human Resources

- Head of Environmental Sanitation

- Environmental Agency

- Education Agency

- PAUD Division

- Population Control, Family Planning, Female Empowerment and

Child Protection Agency

- Head of Family Resilience

- Education Implementing Agency



Cikalong Kulon; Desa Cikancana, Desa

Ciwalen, Desa Kamurang

- Village Committees

- Village Heads

- Community members

- Health Coordinator

- Head of Puskesmas

- Environmental Health staff

- PAUD operators



- PAUD staff

- PAUD teachers

- Midwife

- Nutrition staff

Maluku Province

Provincial Government

District Government of Maluku Tengah - BAPPEDA

- District Planning Officer

- District Finance and Asset Management Agency

- GSC District Office

- GSC Team

- Social Agency

- Housing and Settlements Agency

- Village Empowerment and Development Agency

- MCA-I Team

- Health Agency – Data Collection Officers, Finance and Planning

Officers,

- Head of Pharmacy Division

- Staff of District Health ((Maternal and Child Health, Nutrition,

and Family Planning, Health Promotion)

- Public Works Agency

- Water and Sanitation Division staff

- PAMSIMAS District Coordination

- Implementing Water Supply Systems Division

- PAMSIMAS staff

- Education Agency

- Head of Planning Division

- Staff of Planning Division

- Staff of PAUD Division



Tehoru; Mosso Village

- Village Head

- Village Committee

- Community members

- Head of Puskesmas

- BOK Treasurer

- Midwives coordinator

- Nutritionist

- Cadres

- Mothers

- Fathers


Consultations undertaken for supporting preparation of the INEY Program.

1. National Consultations

Date Location Stakeholders consulted Topics discussed

08/12/2017 Bappenas Basah Hernowo

Direktur Sistem & Prosedur

Pendanaan Pembangunan, Bappenas

KRISNA (Kolaborasi Perencanaan dan Informasi

Kinerja Anggaran, or collaborated planning and

budgeting performance information) which is an

application built by Bappenas and currently used by the

line ministries to develop their annual work plans

(Renja-KL);

The process of planning a program as National Priority

PP 17/2017 that will require a data sharing and

synchronizing of both KRISNA and RKA-KL (DG

Budget’s application for work and budget plan)

11/12/2017 MOF Sudarto

Direktur Sistem Informasi dan

Teknologi Perbendaharaan; Ditjen

Perbendaharaaan MOF

Indonesia FMIS (SPAN) to capture each of individual

Central Government payment transactions and to

generate financial reports

OM-SPAN (on-line monitoring) SPAN to produce

budget realization data in detail by unit organization,

economic classification, and output

Budget execution process

13/12/2017 Ashley Hotel

Stunting

Measurement

Survey

Workshop

TNP2K

BPS (Central Statistics Bureau)

MOH Riskesdas

Survey Meter

Discuss and asses local experience and global regarding

Stunting measurement including experience from

Riskesdas

13/12/2017 TNP2K

Office

Bambang Widianto, Deputy to the

VP, Human Development and

Equitable Development Policy

Support/Executive Secretary TNP2K

Lucky Alfirman, Director General of

Budget Financing and Risk

Management - MOF

Suahasil Nazara, Head of Fiscal

Policy – MOF

Askolani, Director General of Budget

Subandi, Deputy Minister for Human

Development, Community and

Culture – Bappenas

Kennedy Simanjuntak, Deputy

Minister for Development Financing

Kick off Meeting

14/12/2017 TNP2K

Office

Workshop on

Delivery

Units

The current practices and approaches of TNP2K Office

in dealing and managing its key stakeholders, in

particular line ministries and agencies that are involved

in poverty reduction efforts in carrying out its duties

and responsibilities;

The challenges TNP2K Office in carrying out its duties

and responsibilities;

The current scope of works, duties, responsibilities and

accountabilities of TNP2K Office as well as the current

capacities and capabilities of the Office in running its

tasks and duties

The background, scope of works, mandates, challenges,

success story and lessons learn from PEMANDU

Malaysia that TNP2K might benefit from



Discussions around key national priorities as the targets

for PEMANDU, the former UKP4 and TNP2K Office

A brief comparison between the former UKP4,

PEMANDU and TNP2K in terms of structures and

hierarchies, mandate, scope of works, managerial

approaches, accountabilities and results

20/12/2017 Aston Rasuna,

Kuningan

dr. Riskiyana Sukandhi Putra, M.Kes,

Director of Health Promotion and

Community Empowerment

Healthy Indonesia Program with Family-Based

Approach (Program Indonesia Sehat dengan Pendekatan

Keluarga, PIS-PK)

Community Movement for a Healthy Life (Gerakan

Masyarakat Sehat, Germas)

Stunting Campaign

20/12/2017 MOH drg. Saraswati, MPH, Director of

Primary Healthcare

Puskesmas revitalization

Puskesmas planning cycle

Puskesmas accreditation

Puskesmas Berprestasi Award

Puskesmas Information System

11/01/2018 Hotel Ashley

Kementerian Koordinator PMK

Kementerian Kesehatan

Kementerian Keuangan

TNP2K

Bappenas

Discussion on Development of DAK Health for 2018 &

2019 (thematic Stunting)

11/01/2018 MOSA Andi ZA Dulung, DG PFM

15/01/2018 MOH Doddy Izwardy, Director of

Community Nutrition – MOH

Introduction of length-mat as a stunting awareness tool

16/01/2018 Hotel

Borobudur

Askolani, Director General of Budget

Elan Satriawan, Head of Working

Groupu Monitoring and Evaluation –

TNP2K

Pungkas Ali, Director of Health and

Community Nutrition – Bappenas

Kunta Nugraha, Director of APBN

Budgeting – MOF

Eka Hendra Permana, Climate

Change Fiscal Policy – BKF

Purwanto, Director of Budget for

Human Development and Culture

Understanding the government’s system on the program

planning, budgeting, execution and reporting of central

government budget

Learning the example of Budget Tagging on Climate

Change Program that is done by Fiscal Policy Office

Getting inputs from line ministry on their current

practices in planning and budgeting the stunting

reduction as a government national priority program

16/01/2018 MOSA Dillon Zufri, Dewie Ratnasari, Citra

Utami BPNT technical team /

Assistant to DG PFM

Information sharing about Government plan to address

stunting and how BPNT could help address it.

Explanation about the workings of modalities of World

Bank Support. Agreement to share data and information

about current and planned BPNT operation

16/01/2018 MOEC Ella Yulaelawati, Director for ECED Confirming that Directorate’s priority is 3-6 and that 0-

2 is within Directorate for Parenting

17/01/2018 TNP2K

Included

BPNT/Rastra

in INEY

Elan Satriawan, Head Working Group

M&E TNP2K

Included BPNT/Rastra in INEY

17/01/2018 MOH Susiyo Luchito, Okta Iskandaria,

Bureau of Planning and Budgeting,

MOH

Discussed MOH’s Holistik Integrative Stunting

Intervention Approach, and coordination efforts within

and across sectors

Formulation/preparation of Annual Plan and allocation

of funds under various schemes/programs

18/01/2018 TNP2K

Office



Produksi dan

Penempatan

Materi

Kampanye

Stunting 2018

18/01/2018 MOH Dr. Eni Gustina, MPH, Directorate of

Family Health

Healthy Indonesia Program with Family-Based

Approach (Program Indonesia Sehat dengan Pendekatan

Keluarga, PIS-PK)

Kelas Ibu Hamil and Ibu Balita

MNCH Book (the pink book)

SDIDTK, MTBS

19/01/2018 MOH Dr. Mawari Edy, Kepala Bidang

Pendayahgunaan SDM, RR. Endah

Khristanti Wahyu, Kepala SubBidang

Pendayahgunaan SDM Daerah

Khusus, BPPSDM

Human resource for health planning and distribution

Nusantara Sehat: recruitment, deployment, training,

complaint handling

Zero growth policy (PNS moratorium)

Task Shifting

19/01/2018 MOEC Sukiman, Director of Parenting Introducing PforR, Fiduciary and Safeguard

Assessment

19/01/2018 MPWHH Dodi Krispatmadi, Director of

Environmental Health Development

M Sundoro, Director of Water Supply

Development

Dwityo Akoro Soeranto, Director of

Integrated Settlements Infrastructure

Program and activities on water supply development

Strategy to increase convergent delivery for stunting

reduction

20/01/2018 MOEC Nurzaman, Secretary to DG for

Teacher

Introducing PforR, Fiduciary and Safeguard

Assessment

22/01/2018 Bappenas

discuss

stunting PER

& expenditure

framework

Pungkas Ali, Director of Health and

Community Nutrition – Bappenas

Socialized the PER stunting activities and the

connection with P4R INEY project

Get input and comment from Bappenas to enrich PER

stunting analysis

MoF perspective in looking at PER stunting : more on

fiscal space

Bappenas perspective in looking at PER stunting : more

on the efficiency issues especially on specific

intervention

Discussed stunting intervention definition that can be

used for PER stunting

22/01/2018 The Falatehan

Hotel

HDW

Training

Provincial Coordinators, Subdistrict

Facilitators, KPMDs and Generasi

Cadres of:

NTB

West Java

West Kalimantan

Gorontalo

Maluku

22/01/2018 MOH Giri Wurjandaru and Dakhlan,

Directorate of Community Nutrition

Key nutrition interventions delivery arrangement and

budget

PSG

e-PPGBM

22/01/2018 MOH Dr Imran Agus Nurali, Director of

Environmental Health, Sonny,

Kasubit PASD, Kristin, Elly, Kasubit

TU, Director of Environmental

Health

Community Led Total Sanitation/STBM program and

activities by central and district government

Mechanism to monitor result and areas for improvement


reduction

23/01/2018 Bappenas

Development in the preparation of GOI annual work

plan (RKP)



DAK Stunting

Discussion

with Pak

Firman

Bappenas thinking on policy direction for DAK 2019

23/01/2018 TNP2K

Meeting with

TNP2K to

discuss

stunting PER

and

expenditure

framework

Elan Satriawan, Head of Working

Group M&E – TNP2K

Discussed the stunting intervention definition and

method used to collect 100 local government relate

stunting expenditure

Discussed the role of TNP2K in the local government

spending data collection and monitoring

Discussed underlying data and method to select 100

priority district

24/01/2018 MOH Directorate of Health Promotion and

Community Empowerment

Program and activities by central and district

government

Linkage with other program and ministries for content

development

Mechanism to monitor result and areas for improvement


reduction

31/01/2018 MOH Dr. Embry Netty, M.Kes, Head of

BBPK Cilandak

Cascade training for Mindwives and Nurses

07/02/2018 Borobudur

Breakfast

meeting on

DAK Stunting

Design

Putut Hari Satyaka (MOF)

Irianto Nainggolan (MOF)

Consultation on DAK Stunting Design and DAK pilot

08/02/2018 MOEC Haris Iskandar, Director General of

ECED

Confirming that Parenting Education is MoEC’s

program for Stunting Reduction. Discussion on longer-

term possibility of DAK BoP PAUD to support

Parenting Education.

13/02/2018 MOEF Ms. Sinta Saptarina- Director and

staff (Ms. Euis and Ms. Mitha)

Medical waste management and safe handling; relevant

policy and regulation

14/02/2018 MOH

Windu, Bureau of Planning – MOH

Socialized the PER stunting activities and seek possible

collaboration with MOH as there is assignment to this

unit to analyse expenditure relate to stunting

Discussed stunting intervention definition that has been

used by MOH

19/02/2018 MOH Susiyo Luchito, Bureau of Planning MOH monitoring and evaluation mechanism

19/02/2018 MOEC-

Directorate

for Parenting

education)

Dr. Sukiman – Director of Parenting

and staff

Understanding vision for Parenting Program in 1000

days and its contribution to reduce stunting; identifying

entry points for improvement regarding environmental

and social systems; looked at 1000 HPK learning

materials and delivery of parenting sessions through

PAUD.

21/02/2018 MOH-

BPPSDM

Dr. Mawari Edy - Head of Human

Resources

RR. Endah Khristanti Wahyu - Head

of Special Utilization of Human

Resources

Mobilization of staff for Fasyankes/Puskesmas in

districts, including preparation and training

05/03/2018 Bappenas Dr. Kennedy Simandjuntak, Deputy

Minister for Development Financing

Ir. Ade Kuswoyo, Deputy Director

for Multilateral Cooperation

Discussed GFF implementation arrangement for the IPF

component



26/02/2018 Bappenas,

TNP2K

Dr. Elan Satriawan, Head of Working

Group, M&E, TNP2K

Dr. Pungkas Bajhuri Ali, Director of

Health and Community Nutrition,

Bappenas

Ir. Ade Kuswoyo, Deputy Director,

Multilateral Cooperation

Discussed about IPF component that includes GFF

process and implementation arrangement in Indonesia

and activities that will be financed under IPF

component

08/03/2018 MoH-

Directorate of

Community

Health

Ir. Doddy Izwardy, Director of

Nutrition

Dr. Rizky, Director of Health

Promotion

Dr. Eni Gustina, Director of Family

Health

Discussed behavioural change communication,

particularly interpersonal communication through home

visits as one of the DLIs that MoH will be responsible

for.

09/04/2018 Mandarin

Oriental

Hotel, Jakarta

central ministries, including MOHA,

MOEF, MOH as well as

representatives from Central Maluku

District, Gorontalo Province, Cianjur

District of West-Java, Central

Lombok District of NTB and

Ketapang District of West

Kalimantan

INEY PforR; ESSA Process and Findings. Minutes of

meeting can be found in Section 7 of this Annex.

2. Generasi ISM/ INEY Social, Talaud District, November 2017


12/11/2017 DPMD

Secretary

Office

DPMD Secretary Mission objective

Villages to be visited

13/11/2017 Health

Agency

Understanding annual planning and budgeting re

programs around health, nutrition and GSC, monitoring

systems

14/11/2017 Education

Agency

Head of PAUD section Understanding role of education agency re programs

around early childhood education, annual planning and

budgeting, incentives, capacity building

15/11/2017 Provincial

GSC

GSC Provincial Coordinator Understanding role re GSC

14/11/2017 Puskesmas

Damau

Head of Puskesmas Damau Understanding incentives, accreditation, planning,

budgeting, coordination with health agency, challenges

and limitations

14/11/2017 Desa Bantik

Desa Ensem

Desa Rainis

Desa Damau

Desa

Pangeran

Posyandu cadres

Posyandu operators

GSC Facilitators

GSC Treasurer

PAUD cadres

PAUD operators

Beneficiaries

Understanding GSC activities, incentives, coordination,

planning and budgeting, capacity building

Benefits and limitations of GSC

Impressions of GSC

3. INEY Mission, Gorontalo District, February 2018


06/02/2018 BPMD

Gorontalo

Office

BPMD/Community and Village

Empowerment Office

Bappeda/District Planning Office (Bu

Rola)

Dinas PUPR/District Public Work

Office (Pak Firman, Pak Mukhlisan)

Mission objective

Villages to be visited

Schedule re-arrangement for technical meeting



Dinas Kesehatan/District Health

Office (Bu Sukarni)

Provincial Coordinator-GSC Team

District Coordinator-GSC Team

07/02/2018

Bappeda

Gorontalo

Office

Bappeda (Pak Ichsan, Bu Rola)

Dinas Kesehatan (Bu Sukarni, Bu

Sita)

Dinas Pendidikan

Dinas PUPR (Pak Firman, Pak

Mukhlisan)

Dinas Perumahan & Permukiman

(District Housing/Human Settlement

Office)

Provincial Coordinator GSC Team

District Coordinator GSC Team

PAMSIMAS Team (Provincial

Coordinator, Local Government

Specialist, Water and Sanitation

Specialist, District Coordinator)

District systems and possibility to support convergence

program for Stunting Reduction:

priority setting

coordination forum

monitoring and evaluation process

incentive mechanism

policies support

Locus of DAK 2018 and possibility for re-allocation to

10 priority villages

Program and budget (various financing)

07/02/2018

Puskesmas

Kec.

Pulubala-

Gorontalo

Staff of Puskesmas Pulubala, Pulubala

district

To assess the health and nutrition services at Puskesmas

and villages (the planning, budgeting, forecasting,

implementation, M&E, reporting/MIS, supportive

supervision, in service training, convergence with other

sectors)

To conduct FGD among mothers, health workers to pre-

test the length mat.

7-8 Feb

2018

Desa Bakti

Kec Pulubala,

Desa Kayu

Merah and

Desa Liyodu

Kec

Bongomeme,

Desa

Tabumela Kec

Tilago

Head of Village, village committee,

village midwives, nutritionist, cadres,

mothers, and fathers, BPPSPAMs

(Desa Liyodu)

To review the village planning, budgeting,



sectors (esp with water and sanitation)

To review HDW, the posyandu implementation



09/02/2018 Bappeda

Office

Bappeda (Pak Ichsan, and Bappeda

Secretary)

Dinas Kesehatan (Bu Sita)

Dinas PUPR (Pak Firman, Pak

Mukhlisan)

Data collection: DPA and RKA (FY 2017 and 2018)

related to sensitive intervention

Clarify availability program in 10 priority villages

09/02/2018 District Health

Office

District Health Officer (Bu Sukarni) To review the district health office planning, budgeting,



sectors

3. INEY Mission, Lombok Tengah District, February 2018


06/02/2018 Bappenda

Lombok

Tengah

Zainal Mustakim, Kabid Sosial

Budaya, Bappeda,

Annusapati, Kasubbid Pendidikan,

Bappeda

Introduction to mission’s objective and stunting

convergence program;



Arief Djoko, Kasubbid Kesehatan,

Bappeda

District’s understanding, policy, budget, regulation,

strategy, target and updated achievement to address

stunting;

District monitoring system;

District budget; and

Request access to other dinas.

One data pilot: Sistem Layanan Rujukan Terpadu

Ps. Earlier, in the morning, we were invited to join the

TKPKD’s coordination meeting to discuss about

stunting. Hence, we basically have met with all dinas’

representatives and heard stunting issues in their

perspectives.

07/02/2018 Bappeda

Lombok

Tengah

Yusuf Anshori, Kabid Litbang Ekpol,

Bappeda

Drh. Taufik, kasubdit Monev, Ekpol,

Zamzami, Kasubdit perencanaan,

Ekpol

DAK, e-planning, decision making process for DAK at

district level

Elaborate about possibility of piloting DAK-

Programmatic.


Office

H. Omrah, Head of Health Dinas

Kusriadi, Kabid Gizi, Head of

Community Health Division

Lalu Malik, Kasubdit Kesling dan

Kesgaor, Head of Subdivision

Environmental Health

H. Hasyim, Kabid Kesmas, Head of

Disease Control and Environmental

Health Division

PAMSIMAS district team.

GSC district team

District health office policy, target, budget and issues

with regards to stunting.

Elaborate on nutrition specific intervention and

nutrition sensitive intervention, in particular Water and

Sanitation.

Elaborate possibility to piloting DAK Programmatic.

07/02/2018

Public Works

office

Suraji, Kasi Air Minum dan Sanitasi,

Syam, Kabid Infrastruktur

Access to rural water and sanitation, demarcation of

roles and responsibility between Public Works office,

Settlement office, and Environment Office and issues

with regards to Padat Karya and stunting program.

Elaborate possibility to piloting DAK programmatic

and how to do it.

Some concerns about changing approach, from

community-based such as PAMSIMAS and STBM to

Padat Karya.

07/02/2018 Unit Layanan

Pengadaan/

ULP

(Procurement

Unit)

Helmi Qazwaini – Head of ULP

Procurement process in Lombok Tengah

07/02/2018 LPSE

(Electronic

Procurement

Service)

Sunarno – Head of Subdivision of

Electronic Procurement

E-procurement process in Lombok Tengah, including the

electronic system and server

08/02/2018 Desa Mekar

Sari, Praya

Barat

Kepala Desa and team,

Nutritionist Puskesmas, Bidan desa

and posyandu cadres,

Kepala dusun and some community

members,

HDW, GSC, PAMSIMAS consultants

Their understanding about stunting prevention program,

their follow up plan, demarcation of roles and

responsibility to address stunting.

Access to water and sanitation and other behavior

(marriage, family planning, changing names, food

intake, education, ect.)

Adjustment of APBDes to address stunting.


Mangkung

Head of Puskesmas, Nutritionist,

sanitarian, treasury

Puskesmas plan, activity, and budget to address

stunting.

Access to wash, nutrition, stunting case, health service.



Possibility to conduct DAK programmatic pilot

M&E system and capacity building strategy

08/02/2018 BPPSPAMs

Mertak Jumat,

Bangket

Parak, Pujut

Disahari, Ketua Asosiasi BPPSPAMs

Lombok Tengah

Awareness of stunting program, relation between wash

and stunting,

Role of BPPSPAMS to support stunting prevention

program,

Issues and support needed by BPPSPAMs to accelerate

wash access and support stunting


Office

Putrawangsa, MPH (Sub Bagian

Perencanaan)

Ikromudin Idris, Ns (Seksi Gizi

Masyarakat)

Sudarman S.Kep (Seksi Promosi dan

Pemberdayaan Masyarakat)

H. Hasyim, SKM, MM (Bidang

P3KL)

District health office planning, budgeting, supportive

supervision, convergence with other sectors

Delivery arrangement for key interventions

MIS for key interventions

DAK Fisik and Non Fisik planning and proposal

process

BOK Puskesmas planning and utilization

Budgeting process for Dinas and Puskesmas

08/02/2018 Lombok

Tengah,

BPKAD

(District

Finance and

Asset

Management

Office)

Bowo Susatyo, Secretary of BPKAD

Ida Ayu Wayan Maret – Head of

Budget Division, BPKAD

Zuryati – staff of Treasury Division,

BPKAD

Kusna Hariyadi – Head of Treasury

Division, BPKAD

Reporting mechanism for DAK Fisik, Non Fisik, and

Dana Desa

Budget planning process

Disbursement realization of DAK 2017

Implementation of DAK Fisik/Non Fisik and possibility

to adjust locus/focus

Role of KPPN on DAK reporting

09/02/2018 Health Office,

Lombok

Tengah

H. Hasyim, kabid Kesmas,

Darlan, Fasilitator STBM

Kabupaten/staf PNS Kesmas

Issues related to sustainability of wash (quantity,

quality, continuity, affordability),

STBM strategy and target,

Plan for integration with nutrition to address stunting,

Clarify data.

09/02/2018 Health Office,

Lombok

Tengah

M. Ali, S.Kep (Seksi Sistem Info

Litbangkes)

Baiq Atmawati (Seksi Kesehatan

Keluarga)

Dwinta (Sengkol Midwive)

SIKDA Generik

e-Puskesmas

MIS for MNCH, including OpenSRP pilot project

In service training for midwives and refresher training

for cadres

Provision of Kelas Ibu

09/02/2018 KPPN (State

Treasury

Regional

Office)

Henry Rosamirandha, Head of Section

of Bank

Process of DAK reporting by district

4. INEY Mission, Cianjur District, February 2018


07/02/2018 Bappeda

Office

Ali Mahmudin, Kepala SubDit Sosial

Budaya

Pak Cupit, Fungsional Perencanaan

Dinas Kesehatan Staff (Trisna

Gumilar, Kepala Dinas Kesehatan, Dr

Irvan, Kepala Bidang KesMas,

Kepala Puskesmas, Aisyah

Foundation staff (In a Bappeda side

event)

Meeting to discuss the objective of the mission and to

prepare for technical meetings with the different

departments in the district.

Briefly discussed district convergence planning for

stunting reduction.

Received inputs on challenges in the puskesmas, and

challenges in implementing nutrition-specific and –

sensitive interventions in the sub-district and village.

07/02/2018 Bupati Office H Herman, Wakil Bupati

Trisna Gumilar, Kepala Dinas

Kesehatan

Meeting to discuss the objective of the mission and to

prepare for technical meetings with the different

departments in the district.



Briefly discussed district convergence planning for

stunting reduction.

07/02/2018 Dinas

Kesehatan

Ibu Liste, Kepala Seksi PromKes

Ibu Teni Hernawati, Kepala Seksi

Kesehatan Keluarga Gizi

Ibu Aning Yuningsih, Kepala

Instalasi Farmasi Dinas Kesehatan

Ibu Rita Surtini, Staff Seksi






sectors

08/02/2018 Dinas

Pendidikan

Kab. Cianjur

Ruhli Solehudin, Kasi PAUD Assessment of PAUD activities and opportunities to

focus on stunting-relevant ages (0-3) and parental

counseling

08/02/2018 Dinas

Pengendalian

Penduduk,

Keluarga

Berencana,

Pemberdayaa

n Perempuan

dan

Perlindungan

Anak

(DPPKBP3A)

Drs Ade Suherilan Sofyan, Head of

Family Resilience

Discussion on Dinas activities at the district, subdistrict

and village level related to stunting interventions,

particularly counseling for parents on stunting health

and education.

08/02/2018 Dinas

Kesehatan

Dr Sanny Sanjaya, Ketua Bidang

SDK

Ibu Kiki Yunita, Ketua Seksi Alkes)




supervision, in service training, staffing, convergence

with other sectors


Cikalong

Kulon

Pak Alfian, Staff Seksi Kesehatan

Lingkungan

Dr Budi Bakhtiar, Kepala Puskesmas

Ibu Imas, Koordinator Bidan

Ibu Ela, Bidan

Pak Kang Hidaya, Staff Gizi

To review the puskesmas planning, budgeting,



sectors.

08/02/2018 Kecamatan

Sukaresmi

UPT Dinas

Pendidikan

Kec.

Sukaresmi

Heri, Penilik PAUD Assessment of PAUD activities and opportunities to

focus on stunting-relevant ages (0-3) and parental

counselling

08/02/2018 Desa

Cikancana

Kantor Desa

Cikancana

Pos PAUD

Anggur

(Terintegrasi

Posyandu)

Pos PAUD

AL Hasanah

Desa

Cikancana

Suryadi, Village Sekretariat

Ibu Cucu Sumiyati, Kepala/

Pengelola Pos PAUD Anggur

Ibu Yuli, Guru PAUD

Ibu Imas, Guru PAUD merangkap

Kader Posyandu

Ahmad Badri,

Pengelola Pos PAUD AL Hasanah

Assessment of village planning, monitoring and

evaluation processes and education activities related to

stunting, particularly timing of activities, staffing, and

capacity. Discussion on stunting rates in village and

possible interventions.

PAUD activities related to stunting. Discussion on

emphasizing ages 0-3 and possibility of adding parent

counselling



Kec.

Sukaresmi

08/02/2018 Desa Ciwalen Budiyanto, Head of Village Assessment of village planning, monitoring and

evaluation processes and education activities related to

stunting, particularly timing of activities, staffing, and

capacity.

08/02/2018 Desa

Kamurang

Kepala Desa

Pak Kang Hidaya, Staff Gizi

Ibu Imas, Koordinator Bidan

Village Midwife

Villagers


implementation, supportive supervision, posyandu

facilities, convergence with other sectors

Focus group discussion with selected villagers on IYCF

practices, and household diet.

08/02/2018 Dr Eva

Fatimah,

Kepala

Bidang P2P

Dr Eva Fatimah, Kepala Bidang P2P

Ibu Rita Surtini, Staff Seksi


Ibu Sri, Kepala Seksi Kesehatan

Lingkungan

Ibu Meita, Ketua Seksi Farmasi

Ibu Sanny, Ketua Seksi SDM




supervision, in service training, staffing, convergence

with other sectors

08/02/2018 Dinkes

Kabupaten

Cianjur

Head Section Environmental

Sanitation- Ibu Sri-

082218250499

Medical Waste Management at Fasyankes


CIKALONG

Kab. Cianjur

Head of Puskesmas and Env.Health

officer

Medical waste handling, storage, permitting

08/02/2018 Dinas

Lingkungan

Hidup

(Environment

al Agency)

Kab. Cianjur

Secretary of Dinas-Bapak Deden

(08122311743 and Pak Iden, Ibu Evi

(Waste)-085797119710

Law enforcement of regulation related to medical waste

handling from Fasyankes

08/02/2018 Kamurang

Village

Head of Village Water supply and sanitation priority

5. INEY Mission, Ketapang District, February 2018


12/02/2018 District

Secretary

Office

Sekretaris Dinas PU dan Tata Ruang

Kasie Perencanaan

Sekretaris Dinas Kimrum

Kabid Kesmas

Kadis Kesehatan

Mission kick off meeting

Discussion on WASH

Desa

SukaMaju

Posyandu cadres

Posyandu operators

Beneficiaries

Socializing length-mat to posyandu operators and

cadres

Discussion on informed consent, access to information,

early pregnancies and marriages, FGM, traditional

practices

Desa

SukaBangun

Posyandu cadres

Posyandu operators

Beneficiaries


cadres



practices

Desa Ulak

Medang

Posyandu cadres

Posyandu operators

Beneficiaries


cadres



practices


6. INEY Mission, Maluku Tengah District, February 2018


12/02/2018 District

Secretary

Office

Asisten II Setda

Dinas Kesehatan

Dinas Pendidikan

Dinas Sosial

Dinas Pekerjaan Umum

Dinas Perumahan & Permukiman

Dinas Pemberdayaan Masy & Desa

GSC team

PAMSIMAS Team

MCA-I Team

Mission objective

District systems and possibility to support convergence

program for Stunting Reduction

Schedule arrangement for technical meetings with

different district offices

13/02/2018 District

Health Office

District Health Officers, including

Data Collection Officers and a

Planning Officer

Data collection, reporting and M&E systems in the health

sector, including data quality assurance mechanisms,

design of the M&E system and the use and dissemination

of the collected results information.

13/02/2018 District

Health Office

Division of Environmental Health

Officer (Bu Sukma)

FY 2017 and 2018 Program and budget (target output,

locus, financing source)

CLTS/STBM implementation and monitoring

challenges

Sanitarian performance and incentive

Coordination with other programs/sectors

13/02/2018 District

Health Office

Kusranggi L – Staff of Planning and

Finance

Ismail – Staff of Planning and

Finance

Planning and timeline of DAK Fisik preparation

Planning, implementation and reporting of BOK

13/02/2018 District

Planning

Office

District Planning Officer (Pak Joko) Review of monitoring and evaluation arrangements for

the District Development Plan, including the collection

of routine monitoring information and the use and

dissemination of data.

13/02/2018 BPKAD

(District

Finance and

Asset

Management

Office)

Wisen Titaley – Staff of Treasury

Division, BPKAD

DAK Reporting mechanism through OM-SPAN

Reporting mechanism from Dinas to BPKAD

13/02/2018 District Public

Work Office

Rikonusa Waelerony (Officer-PPK

PAMSIMAS)

M Nur (Officer-Division of Water

and Sanitation)

Lusan Marini Putri Siregar

(PAMSIMAS District Coordination)



Challenges in provision of access to clean water in rural

areas

Monitoring system to subdistrict and village level

BPPSPAMs performance and incentive

Coordination with other programs/sectors

13/02/2018 District

Education

Office

Katarina Latarissa – head of Planning

Division

Sani Tehuwayo – Staff of Planning

Division

Dewi Tuasikal – Staff of Planning

Fivision

Sitra Silawane – Staff of ECED

Division Education Officer

Review of District monitoring and evaluation

arrangements for the Ministry of Education, including

the collection of routine education data and monitoring

information and the use and dissemination of data.

Utilization and reporting of BOP PAUD

13/02/2018 District Social

Office

Head of department/Kepala Dinas

Secretary of department /Sekretaris

Dinas



Human resources and challenges to increase health

insurance coverage for poor/vulnerable group



Coordination of PKH program with other

programs/sectors


Kecamatan

Tehoru

Nutritionist and midwives at

Puskesmas Tehoru





sectors

13/02/2018 Mosso Village Head of Village, village committee,

village midwives, nutritionist, cadres,

mothers, and fathers




sectors

To review HDW, the posyandu implementation



14/02/2018 District

Health Office

Staff of District Health Office

(Maternal and Child Health,

Nutrition, and Family Planning,

Health Promotion)

To review the district health office planning, budgeting,



sectors

To review District Pharmacy and medicine supply

division and DAK Pharmacy

14/02/2018 District

Health Office

Hendry Novrial – Head of Section for

Pharmacy

Review of district Pharmacy and medicine supply

division

Understanding the usage of DAK Fisik Pharmacy and

BOK Pharmacy Distribution


Layeni

Dr. Claartje Leunufna – Head of

Puskesmas

Midwives coordinator

Josemina – BOK Treasurer





sectors

To review BOK

14/02/2018 Desa Trana Head of Village

Planning and Health Officers

BPPSPAMs

Review of Village planning and M&E arrangements,

including performance review mechanisms and citizen

feedback on service delivery.

Review of data collection mechanisms, including

reporting templates and quality assurance mechanisms.

Inclusion of stunting target group as priority target in

expansion plan of water and sanitation services


7. ESSA Validation Workshop, April 2018

Participant List of the ESSA Validation Workshop


Minutes of the ESSA Validation Workshop

Date : April 9, 2018

Venue : Mandarin Oriental Hotel, Jakarta

Participants : See the list of attendance

Themes Feedback/inputs

Program-related

design

Central Maluku Representatives

- Further clarity with regards to institutional arrangements, particularly roles and

responsibilities at the district level is needed to enable interventions to be synchronized.

At this stage, the program’s arrangements are not fully understood and/or

communicated to the district governments. Therefore guidance for institutional

arrangements within districts is required.

- Stunting issues tend to affect in-land, remote communities, who are hard to reach and

hence, underserved. There are issues with regards to the availability of basic services as

well as accessibility to say the least. Some of the key roles for the delivery of basic

services are assumed by non-government stakeholders, e.g. church and therefore, their

participation needs to be considered.

Gorontalo Representatives

- While the national medium-term plan (RPJMN) has incorporated stunting interventions,

the district medium-term plan (RPJMD) is yet to follow suit. The program would imply

the need for revisions to the current RPJMD, which could not be done quickly.

- Proposed nutrition-specific interventions under the program may only partly address the

issues, but the major root-causes may stem from environmental health and

social/behavioral factors. Human Development Workers (HDW) supported as a

convergence instrument under the Program, while strategic, would require concerted

efforts to ensure sustainability e.g. skills development, incentives, distribution, etc.

- The delivery of basic services that are in need under the Program would fall under the

purview of village governments, and therefore there is a need to align this with the

implementation of the Village Law to enable proper use of village funds (Dana Desa

and Alokasi Dana Desa);

- The new presidential regulation PP 2/2018 on basic minimum standards for basic

services would require inter-agency collaboration for the regulation to be operational,

which still remains a challenge.

Central Lombok Representatives

- Village-led initiatives to support basic services exist and could be strengthened by

improving village-level facilitation as well as governing regulatory frameworks with

regards to the use of village funds;

- The data on stunting was only recently made available despite the earlier programs

supported by the World Bank, including PNPM and GSC, which now represent a

missed opportunity to address the issues.

Posyandu and

overall delivery of

basic health

services, including

reproductive

health


- The provision of food supplements (Program Makanan Tambahan-PMT), as envisioned

by the GoI, still favors factory-made products. Encouraging use of locally sourced food

items is important to ensure sustainability;

- Facilitation at the village level, by strengthening Posyandu cadres’ capacity as well as

revisiting their incentives, is critical to ensure optimal delivery of needed services and

interventions to address stunting;

- Posyandu are still dominated by women/mothers and there have been efforts to promote

involvement of fathers through a tailored session (at least once a month).


- Accessibility remains an issue with remote communities being excluded;



- Some existing interventions are limited in scope, such as the piloting of the

anthropometric survey funded by the MCI, and scaling up this intervention into villages

with pockets of stunting issues would require extra resources and capacity.

- Existing interventions at the village level tend to operate independently and if

convergence is considered as an approach to address stunting, there is a need to ensure

that PAUD services can be integrated into other interventions such as family planning,

parenting, youth education, etc. This would need strengthening facilitation roles of

cadres, collaboration with other sectoral agencies as well as integrated guidelines.

Cianjur Representatives

- Outreach to men or fathers is generally constrained by socio-cultural and economic

factors where men usually act as breadwinners and are therefore perceived to have less

time with children. This would require an intervention that is specifically designed for

men, including seeking their participation in parenting sessions during sessions at

Posyandu.

- Reaching out to adolescent girls would require a tailored approach, including education

on reproductive health, equally, the program could capitalize on the role of mothers to

access this population group.

Maluku Representatives

- Distribution of health workers or the lack thereof especially in remote districts needs to

be addressed, particularly with Ministry of Health (MoH) due to district limited fiscal

capacity to cover remote areas.

Ketapang Representatives

- Frontline health services are mostly delivered through Puskesmas, located in sub-district

capitals and with an extension service in some villages. In this case, not all villages with

pockets of stunted children have the needed facilities to reach them and therefore,

distribution of these facilities and accessibility still remain an issue.

Early Childhood

Education

Services

(ECED/PAUD)


- Current ECED services only cater to children aged two years old and above. This

suggests that children or parents under two, who are the targets of stunting interventions

could potentially get excluded;

- There is the need for parenting education for youth, including education on reproduction

health;

- There is the need to encourage involvement of fathers e.g. perhaps creating Father’s day

once a month could achieve this.

Maluku Tengah Representatives:

- Challenges of access still concern communities found in sub-districts in-land, however

coastal communities do not have this problem;

- There is a lack of human resources, therefore services are provided by religious leader.


- The district government, in collaboration with Education and Health Agencies are

currently developing an integrated PAUD and POSYANDU service which is expected

to enable more systematic interventions and sustained service delivery through

strengthened partnership with village stakeholders.


- Various education programs have been introduced including through PAUD, Posyandu

and Bina Keluarga Balita (BKB);

- GSC is funded by PNPM, whilst PAUD teachers are still working on a voluntary basis.

Ketapang representatives

- For PAUD, there are constraints in the field due to geographical location of

communities. Focus activities in Puskesmas, important role of sanitarian.

Min of Health/Kesling Representative

- What are concrete suggestions for involvement of father? Father’s day?



- Various existing programs relevant to parenting education, including STBM/CLTS-

Community Lead Total Sanitation. There is a special fund (Dana Dekon) that can be

tapped into.

Environmental

hygiene, water

and sanitation


- Empowering village actors, notably cadres and PKK (Family Welfare Movement) teams

to provide outreach to youth and children on hygiene and sanitation.

- Handover of water and sanitation facilities to village governments remains problematic

since existing regulations pertaining to the establishment of facility management teams

and their roles are out of sync with village regulations, causing disconnect and lack of

integration with village planning. Sustainability of operations is also an issue.

- Fiscal regulatory frameworks, particularly with regards to fiscal transfers from the

central government to the district government have certain restrictions that prevent

adjustment of allocation to address context-specific and changing issues.

- In Gorontalo, there are 53 PAMSIMAS project locations, but 14 of them are no longer

functioning.


- Solid waste issues remain problematic, especially in remote areas. The district

environmental agency, through their waste pick-up services, could only serve urban

areas, not rural.

- Access to water and sanitation has improved overtime and some communities now have

access to communal waste water treatment facilities (IPAL). Smoking habits remain

prevalent.


- The GoI has invested a lot in the “hardware” of basic water and sanitation infrastructure

at the village level, yet the “software” including facilitation aspects would still need

strengthening to ensure complimentary services, systematic interventions and local

ownership.

- Additional training, guidelines for development of HDW, midwives and sanitarian with

regards to the benefit of access to water, sanitation and strict adherence of hazardous

waste handling such as sharps, expired products etc.

- It is highly recommended that we use the existing accreditation system of Puskesmas to

tackle the issues with medical waste handling in Puskemas and environmental sanitation

(standard 8.5.2) of Permenkes 46//2015.


- Third party services to handle medical waste are not available due to lack of economies

of scale to attract private investments. Such waste is managed at the facility level;

- It is important to look beyond the existing central government programs, including

PAMSIMAS, due to their limited coverage and there is a need to capitalize on village

funds to expand access to water and sanitation.

- There is still a lack of waste water treatment facilities in many Puskesmas.


- Facilitation is key to enhance accessibility and correct targeting of beneficiaries;

- The handling of household/solid waste needs to be regulated, including supervision of

their enforcement;

- Access to water and sanitation at remote locations is still a huge challenge in Maluku.

Ministry of Home Affairs (MoHA) Representatives

- A new presidential regulation No.2/2018 on basic minimum standards for basic services

is expected to leverage districts’ investments in water and sanitation, as well as other

basic services. The guiding regulations and manuals are currently still being formulated,

and these will provide further clarity with regards to specific incentives, funding

mechanisms, as well as sanctions for failures to meet the standards.

- In RPJMN, the national target for the 100-0-100 program needs to be fulfilled in 2019.



- The PAMSIMAS program does not cover all of the villages therefore there should not

be full dependence on PAMSIMAS to ensure availability of clean water

Medical waste

management

Ministry of the Environment and Forestry (MoEF) Representatives

- The MoEF Regulation No.56/2015 on the guidelines for the handling of medical waste

from health facilities acknowledges that some facilities cannot access third-party

services. Alternative mechanisms, such as burial of such waste, is allowed provided that

they meet certain standards stipulated in the regulation. The District Health Offices are

responsible for oversight and facilitation to ensure compliance of the SOPs.

- There is still a lack of medical waste treatment service companies in Indonesia. So far

there are only 6 companies for the whole of Indonesia. MoEF has established a pilot

project for a medical waste treatment facility in South Sulawesi that is meant to support

eastern Indonesia, however the facility appears to be limited in capacity, so far it is only

able to cover areas around Makassar.


- While basic medical waste handling is available at the district hospital, availability of

such services is non-existent in Puskesmas where such waste is usually buried;

- Private health facilities/clinics are usually not equipped with building permits and this

has prevented issuance of permits for temporary waste handling facilities/storage.


- A third-party medical waste handling service is available (e.g. PT Artha Santoso) and

every Puskesmas in the district has been served.


- While safety boxes have been provided, lack of compliance to the SOPs remains an

issue and this would require strengthened oversight by the district health agency - for

midwives and Puskemas staff.


- Puskesmas are not equipped with medical waste handling facilities due to permitting

and infrastructure constraints, and therefore, burial of such waste becomes a usual

practice.

Vaccination and

supplements,

including

ANC/PNC


- Socio-cultural factors, including belief systems, still prevent people from accessing

vaccinations. This has been associated with the recent Diphtheria outbreaks in the

region;

- Compliance for ANC and PNC (minimum 10 visits) is also problematic among mothers.

Similarly, lack of intake of FE pills amongst pregnant mothers is also observed.

Addressing such issues would require strengthened facilitation and persuasion by

midwives and cadres;

- Issue of compliance by health workers in terms of safe handling of “used needles” -

which may impact environment.


- Issue of cold chains. Recurrent power outages risks vaccine quality/safety;

- Since vaccinations are currently administered through injection, only licensed health

workers, including midwives, are able to deliver such a service. This has implications to

communities and villages with no access to health workers, or with heavy reliance on

cadres (where in the past there were other options e.g. drips which did not involve

injection and therefore could be performed by cadres).

• Challenges regarding ‘fake’ or faulty vaccines place community at risk.


- Puskesmas accreditation schemes can be considered as an instrument to hold facilities

accountable (e.g. compliance to SOPs), however the pressures for delivery of health

services now mostly fall under Puskesmas and there is no mechanism to hold District

Health Agency (Dinas Kesehatan) accountable for their performance.




- While coverage for vaccination and ANC/PNC has improved greatly over time, there is

a lack of understanding with regards to the quality of such services including quality of

immunization due to the problem of cold-chains which affect the quality of vaccines.

Further assessments would be needed to understand health staff and frontline service

workers’ performance as well as people’s perceptions of such services.

Behaviour change

& social mapping


- There was no clear opinion, suggestion or experience over how to create behaviour

change. He projected a view that it is household manager’s responsibility to ensure

children are not stunted, given that women are largely responsible for household – it is

their responsibility to ensure children are not stunted – perhaps it was not understood

that behaviour change is targeted towards parents and adolescents and not children.


- Existing need to increase general knowledge about causes of stunting and methods of

reducing risk of stunting amongst communities; once this is achieved behaviour change

will follow. This can be done through more intensive knowledge delivery and

intervention from HDW and other cadres.


- There must be stronger synergy from central, province, district to village level with

regard to integration of 3 (sectoral) areas; education levels, environmental health, and

economy amongst communities.


- Cadres are essential in creating behaviour change;

- Kartu Indonesia Sehat (Healthy Indonesia Card) should be provided for cadres in the

village as incentives.


- Approach towards behaviour change is increasing capacity of cadres and empowering

community through socialization activities to communities, particularly parents.

- Behaviour change discussion was very short, perhaps further assessment could have

been made.

- No comments made on social mapping.

Ministry of Health/ Kesling-Environmental Health Representatives;

- Efforts to introduce behavior change in STBM/CLTS programs. Example of

implementation in Asmat - within 2 weeks there were successful behaviour changes

towards ODF.


Ringkasan

Kajian Sistem Lingkungan dan Sosial

(Environmental and Social System Assessment -ESSA)

INVESTING IN NUTRITION AND EARLY YEARS (INEY) PROGRAM-FOR-RESULTS (PforR)

INDONESIA

A. PforR INEY dan ESSA

1. Proses ESSA menguji sistem pengelolaan lingkungan dan sosial yang berlaku pada program PforR INEY dalam rangka mengkaji sejauh mana sistem memenuhi persyaratan sesuai Kebijakan Bank Dunia tentang pembiayaan PforR. Proses ini bertujuan untuk memastikan bahwa risiko lingkungan dan sosial program akan dikelola secara memadai dan mematuhi prinsip-prinsip dasar pembangunan berkelanjutan. Ruang lingkup proses ESSA termasuk mengkaji:

a. potensi risiko dan manfaat dari sudut lingkungan dan sosial; b. sistem lingkungan dan sosial yang berlaku untuk program; c. pengalaman dan kapasitas implementasi; d. apakah sistem dan kinerja konsisten dengan prinsip-prinsip utama dari Kebijakan Bank Dunia;

dan e. langkah-langkah yang harus diambil untuk meningkatkan ruang lingkup sistem atau kaupasitas.

2. Program Development Objective (PDO) atau tujuan dari program INEY yang diusulkan adalah untuk: “Meningkatkan pemanfaatan intervensi gizi secara simultan oleh “rumah tangga 1.000 hari” di kabupaten prioritas”. "Rumah tangga 1.000 hari" di artikan sebagai rumah tangga dengan perempuan hamil dan/atau anak-anak berusia 0-24 bulan.

Gambar 1: Distrik Prioritas (2018-2019)


3. Program INEY akan mendukung sebagian intervensi dari program konvergensi pemerintah untuk mempercepat pengurangan stunting (Convergence Program to Accelerate Stunting Reduction- CPASR) serta konvergensi instrumen-instrumen yang sifatnya sangat penting dalam mengkoordinasikan penyampaian semua intervensi prioritas spesifik-gizi dan peka-gizi di lokasi prioritas. Tujuan keseluruhan dari Program Konvergensi adalah untuk mempercepat pengurangan stunting dalam kerangka peraturan dan kelembagaan yang ada. Program Konvergensi akan mendukung pencapaian target Rencana Pembangunan Jangka Menengah Nasional (RPJMN) untuk mengurangi “tingkat kejadian”(prevalensi) stunting dari sebesar 37,2% menjadi 28% pada tahun 2019. Program Konvergensi juga akan mendukung pencapaian target Peningkatan Gerakan Nutrisi (Scaling Up Nutrition; SUN) 2025.

4. PforR INEY mencakup empat result/hasil koordinasi dan konvergen, termasuk:

Result Area 1: Memperkuat kepemimpinan nasional. Result Area 2: Memperkuat pelaksanaan program dan kegiatan sektor. Result Area 3: Memperkuat program dan kegiatan kabupaten. Result Area 4: Konvergensi Penyampaian di tingkat desa.

5. Sekretariat Wakil Presiden (SWP) di Kementerian Sekretariat Negara merupakan institusi yang memimpin (Executing agency) untuk program PforR. Program ini akan melibatkan dua lembaga pendukung (Enabling Agencies; EA) dan tujuh Lembaga Pelaksana termasuk pemerintah kabupaten dan pemerintah desa. Diagram di bawah ini merangkum pengaturan kelembagaan, termasuk bagaimana Sekretariat TNP2K akan mendukung SWP untuk menggunakan indikator (DLI) untuk memantau pelaksanaan di berbagai tingkat pemerintahan.

Gambar 2: Pengaturan Kelembagaan


B. SISTEM LINGKUNGAN DAN SOSIAL YANG RELEVAN

6. Program INEY PforR tidak memiliki sistem tunggal yang terkait dengan kinerja lingkungan dan sosial. Dengan demikian, pengkajian difokuskan pada sistem kunci yang berdampak pada kesehatan, terutama kesehatan seksual dan reproduksi perempuan dan anak perempuan, WASH, dan pemberian layanan pendidikan di tingkat rumah tangga dan desa, termasuk ketentuan dan sistem yang relevan yang memperkuat UU Desa. Demikian pula, pengkajian lingkungan berfokus pada peninjauan kecukupan dan implementasi kebijakan, peraturan dan pedoman nasional yang terkait dengan penanganan, distribusi dan penyimpanan suplemen dan vaksin serta penanganan limbah medis yang aman (di Puskesmas).

C. PERTIMBANGAN DAN RISKO LINGKUNGAN DAN SOSIAL

7. Secara keseluruhan, hasil pengkajian resiko dan penyaringan menunjukkan bahwa dampak lingkungan dari program ini cenderung positif; memberikan beberapa manfaat lingkungan seperti akses ke pasokan air minum yang lebih baik, akses ke fasilitas sanitasi yang lebih baik dan peningkatan kondisi sanitasi. Masalah lingkungan utama terkaitan dengan penanganan yang aman atas limbah farmasi dan sistem pembuangan yang dikelola oleh Posyandu dan Puskesmas; aspek kualitas dan kuantitas (kontinuitas) penyediaan air minum dan sanitasi. Risiko lingkungan diharapkan pada tingkat “moderate”. Potensi risiko lingkungan diidentifikasi sebagai berikut: (I) pembuangan vitamin kedaluwarsa dan penyimpanan kelebihan pasokan vitamin; (ii) penyediaan, distribusi dan penyimpanan vaksin serta pembuangan limbah farmasi (vaksin kadaluwarsa/rusak/tidak digunakan, botol vaksin dan jarum suntik bekas); (iii) aspek kualitas dan kuantitas (kontinuitas) penyediaan air minum dan sanitasi.

8. PforR saat ini tidak berencana untuk mendukung investasi infrastruktur. Kegiatan infrastruktur yang terkait dengan Air, Sanitasi Kebersihan (WASH) didanai melalui proyek PAMSIMAS (P154780). Tidak ada antisipasi dampak buruk terhadap habitat alam, properti budaya fisik, sumber daya alam, atau aset atau mata pencaharian masyarakat berdasarkan kegiatan yang didukung oleh PforR. Pengkajian sistem berkenaan dengan resiko lingkungan dan sosial dan pengelolaan dampak yang muncul dari kegiatan pembebasan lahan, konversi lahan dan kegiatan infrastruktur, tidak termasuk dalam lingkup ESSA ini.

9. Efek sosial cenderung muncul dari kegiatan yang terkait dengan RA 4, (Konvergensi pemberian layanan desa), RA 2 (Memperkuat program dan kegiatan sektor) dan RA 3 (Memperkuat program dan kegiatan kabupaten). ESSA mempertimbangkan efek sosial yang berkaitan dengan kemampuan individu, rumah tangga dan kelompok untuk mendapatkan layanan dengan cara yang mudah diakses, aman, dan inklusif. ESSA juga mempertimbangkan apakah komunikasi edukatif, perubahan perilaku, informasi tentang intervensi khusus gizi, khususnya layanan kesehatan, disampaikan dengan cara yang mempertimbangkan konteks lokal termasuk aspek literasi, bahasa, dan budaya dari penerima manfaat. Hal ini termasuk dalam memastikan penjelasan dan persetujuan serta penyediaan proses pengajuan keluhan dan kekhawatiran. Potensi ketidaksetaraan dan konflik akan berasal dari perbedaan nyata atau persepsi tentang bagaimana manfaat dari program didistribusikan yang membuat pentingnya kebutuhan akan sistem pengaduan yang efektif. Jika sistem tingkat desa inklusif dan partisipatif serta dikelola dengan baik, pihak yang paling rentan akan memperoleh manfaat. Dalam hal ini, diharapkan Masyarakat Adat, jika ada dalam masyarakat yang ditargetkan, harus mendapatkan manfaat dari program dan kelompok rentan dan Masyarakat Adat tidak boleh mendapat dampak buruk. Keluarga miskin, ibu yang berpendidikan rendah, ibu muda, ibu yang lebih tua, ibu yang tidak menikah, keluarga dengan orang tua tunggal atau rumah tangga yang dikepalai oleh anak, dan orang tua dengan


status HIV cenderung menjadi kelompok yang paling rentan. Berdasarkan penilaian di atas, Program ini diharapkan berkontribusi dalan mengatasi masalah kesetaraan dan oleh karena itu tingkat risikonya dinilai rendah.

10. Masyarakat Adat tidak terkena dampak buruk dari kegiatan yang didukung oleh INEY PforR. Informasi yang berkaitan dengan stunting dan nutrisi dan Masyarakat Adat di Indonesia tampaknya terbatas. Untuk setiap layanan dan intervensi yang direncanakan akan ada kebutuhan untuk memahami konteks, aksesibilitas, sistem kepercayaan dan pilihan untuk menginformasikan kesesuaian dan penyerapan layanan atau intervensi yang direncanakan. Idealnya pekerja garis depan harus berasal dari komunitas mereka sendiri dan akan diperlengkapi untuk memastikan partisipasi laki-laki, perempuan dan remaja yang sesuai.

D. PENGKAJIAN SISTEM DAN TINDAKAN YANG DIREKOMENDASIKAN

11. Beberapa usulan kegiatan awal untuk lingkungan dan sosial telah dikembangkan sebagai bagian dari Rencana Aksi/Tindakan Program INEY PforR. Usulan rencana aksi ini perlu didiskusikan dan disetujui secara internal dan dengan pemangku kepentingan eksternal yang berkaitan. Aksi utama meliputi:

a. Upaya Lingkungan - memperkuat kapasitas kelembagaan: mulai dari memberikan pelatihan yang relevan

untuk melaksanakan kebijakan dan panduan teknis hingga melengkapi staf terkait dengan alat dan perlengkapan praktis tentang penanganan limbah farmasi yang aman secara umum dan khususnya sistem pembuangan limbah

- memperkuat kinerja sistem untuk pengelolaan lingkungan yang bertujuan untuk menghasilkan efek lingkungan yang diinginkan: (i) memberikan pedoman teknis untuk pelaksanaan langkah-langkah mitigasi lingkungan yang efektif seperti mendorong pengelolaan daerah aliran sungai (DAS); (ii) menerapkan standar praktik-praktik baik; dan (iii) mempromosikan program cuci tangan yang bermanfaat bagi pembelajaran tahun-tahun awal menuju praktik kebersihan pribadi yang lebih baik untuk anak-anak sekolah.

b. Upaya Sosial: - Penanganan Pengaduan dan Umpan Balik: Tidak ada satu sistem, dan sistem yang adapun

tidak dilengkapi untuk menangkap umpan balik dan keluhan di seluruh intervensi yang direncanakan. Kartu Nilai Konvergensi Desa (Convengence scorecard) diusulkan sebagai sistem yang dipakai sebagai sarana penyampaian umpan balik. Sehingga keluhan dapat diidentifikasi dan ditangani serta dipantau.

- Partisipasi, Akses dan Inklusi: Ada potensi ketidaksetaraan dan ketegangan muncul dari perbedaan yang nyata atau secara persepsi tentang bagaimana manfaat program didistribusikan. Penggunaan human development workers (HDW) dan latihan pemetaan sosial harus memastikan partisipasi yang inklusif yang memperhitungkan gender, konteks lokal, budaya, kepercayaan dan sistem nilai Masyarakat Adat serta kelompok-kelompok yang diidentifikasi sebagai kelompok rentan. Seorang Spesialis Inklusi Sosial sebagai bagian dari Unit Koordinasi di bawah TNP2K sedang diusulkan. Spesialis ini harus memiliki pengalaman khusus tentang Masyarakat Adat, gender dan remaja putri.

E. TINGKAT RISIKO LINGKUNGAN DAN SOSIAL

12. Berdasarkan temuan penilaian dan rancangan mitigasi serta tindakan perbaikan, risiko lingkungan dan sosial dianggap pada tingkat “moderate”/sedang.


F. KETERLIBATAN PEMANGKU KEPENTINGAN DAN “DISCLOSURE” ESSA

13. Dalam penyusunan draft ESSA, tim Bank Dunia berkonsultasi dan melibatkan berbagai pihak dan pemangku kepentingan termasuk pemerintah (pusat, kabupaten dan desa); mitra pembangunan; penyedia jasa; organisasi masyarakat sipil; sektor swasta; dan masyarakat yang terkena dampak dan penerima manfaat serta perwakilan mereka. Setelah melalui diskusi dan mendapatkan kesepakatan tentang tindakan/aksi lingkungan dan sosial serta masukan bagi rencana dukungan pelaksanaan program, tim Bank Dunia akan menyelesaikan draft dokumen ESSA dan selanjutnya di unggah ke situs web Bank sebagai bagian dari prosedur “disclosure” . Draft ESSA yang dibagikan sebelum lokakarya,, akan menjadi bahan diskusi pada lokakarya,, yang akan dihadiri oleh berbagai pemangku kepentingan baik tingkat pusat dan daerah.

G. MEKANISME PENGADUAN

14. Masyarakat dan individu yang menganggap bahwa mereka terkena dampak negatif akibat operasi PforR yang didukung oleh Bank Dunia, sebagaimana didefinisikan oleh kebijakan dan prosedur yang berlaku, dapat mengajukan pengaduan ke mekanisme pergaduanv yang ada atau Layanan Penanganan Keluhan WB (Grievance Redress Service; GRS). GRS memastikan bahwa keluhan yang diterima segera ditinjau untuk mengatasi masalah yang terkait. Masyarakat dan individu yang terkena dampak dapat mengajukan keluhan mereka ke Panel Inspeksi independen WB yang menentukan apakah kerusakan telah terjadi, atau dapat terjadi, sebagai akibat dari ketidakpatuhan WB terhadap kebijakan dan prosedurnya. Keluhan dapat diajukan kapan saja setelah kekhawatiran telah dikemukakan langsung ke Bank Dunia, dan Manajemen Bank telah diberi kesempatan menanggapi. Untuk informasi tentang cara mengajukan keluhan ke Layanan Penanganan Keluhan korporat (GRS), silakan kunjungi http://www.worldbank.org/GRS. Untuk informasi tentang cara mengajukan keluhan ke Panel Inspeksi Bank Dunia, silakan kunjungi www.inspectionpanel.org.

***

http://www.inspectionpanel.org/


Annex 4: Analysis Against Key Policy Elements of Bank Policy Program-for-Results Financing

Policy Element a) Program systems promote environmental and social sustainability in the PforR Program design; avoid, minimize, or

mitigate adverse impacts, and promote informed decision-making relating to the PforR Program’s environmental and social impacts.

Key Attributes related to Core Principles Relevance to Program Provisions in System Practice

Operate within an adequate legal and

regulatory framework to guide

environmental and social impact

assessments at the Program level.

Relevant A complete set of regulatory and legal

framework related to handling, distribution

and storage of supplement, vaccines,

vitamins are available. Also, the regulation

on how to implement immunization

activities. Moreover, regulations on

Primary Health Care facilities is quite

comprehensive including its accreditation

system. Also, a clear distinction between

national, provincial and district level

jurisdiction for permitting system of

Medical waste management handling at

primary care level is available (MOEF

Decree 56/2014) with regulation on

permitting system for wastewater effluent

and emission.

A complete assessment of regulatory

framework related to INEY program is

presented in section D1.

I Sphere Program.

Permit documents are found at HFCs in

the field also all necessary equipment for

waste handling such as dedicated bins for

expired medicines, sharps, infectious

waste. However, the main challenge is to

maintain the same level of performance 2-

3 year after the permit granted for keeping

the practice/equipment running well and

when handling abnormal situation (the

disposal company’s licence is revoked). A

management system for periodic

evaluation, training, annual refresher and

work instructions development for task

with high environmental and social risk is

needed. The capacity of Local

Environmental Agency is still low in

regulation implementation, monitoring

and advice provision.

Incorporate recognized elements of

environmental and social assessment good

practices

Relevant. See below.

(a) early screening of potential effects; National regulatory system on AMDAL

regulates this in more detail. PermenLH no

5/2012 about Environmental Assessment.

Manageable. Ministry of Public Works or

Local contractors has adequate

information related to screen out the

potential natural hazard in the area in





Permenkes 75/2015- Appendix 1-

regulates the requirement of the location of

the Puskesmas that must be free from

natural hazards such as hurricanes, floods,

earthquake (faults), steep slope, tsunami, at

riverbank area (erosion potential) etc.

Element Criteria 2.1.1 of Permenkes

46/2014 about accreditation.

Puskesmas have the necessary valid

building permits and in accordance with

the spatial layout of the district/cities.

addition to information from local

communities.

(b) consideration of strategic, technical, and

site alternatives (including the “no action”

alternative);

Relevant Permenkes 75/2014 about Puskesmas

location and building permit system.

Manageable. See above.

(c) explicit assessment of potential induced,

cumulative, and trans- boundary impacts;

Relevant National regulatory system on AMDAL


5/2012. Also, accreditation system for

waste management storage and transport.

And also, the permitting system for

wastewater effluent and emission and the

manifest system from MOEF

Manageable, in term of the

comprehension that the potential induced

impacts must be taken care of in the

regulation. It has been explicitly assessed

and regulated.

(d) identification of measures to mitigate

adverse environmental or social impacts that

cannot be otherwise avoided or minimized;

Relevant National regulatory system on AMDAL


5/2012.

No significant gap, the measures for

mitigation has been regulated.

(e) clear articulation of institutional

responsibilities and resources to support

implementation of plans

Relevant A clear distinction between national,

provincial and district level jurisdiction for

permitting system of Medical waste

management handling at HCF level is

available (MOEF Decree 56/2014).

Permenkes 1204/2004 also regulates the

Cleary articulated.





required competency for environment

sanitation staff of the HCF.

(f) responsiveness and accountability

through stakeholder consultation, timely

dissemination of Program information, and

responsive grievance redress measures.

MoEF Decree no 17/2012 regulates the

community participation in environmental

assessment for AMDAL and UKL UPL.

Village level systems

Systems associated with health

interventions

No one system.


Policy Element b) Program systems avoid, minimize, or mitigate adverse impacts on natural habitats and physical cultural resources

resulting from the PforR Program.


Includes appropriate measures for early

identification and screening of potentially

important biodiversity and cultural resource

areas.

No adverse impacts to

important biodiversity of

physical cultural heritage.

National regulatory system on AMDAL


5/2012. Permenkes 75/2014 about

Puskesmas location and Permit

Requirement for HCF establishment by

respective jurisdiction.

The location of Puskesmas is always

designed to be close/nearby human

settlement area for easy access and is not

located at protected or sensitive area

(Appendix I.1.b of Permenkes 75/2014).

Supports and promotes the conservation,

maintenance, and rehabilitation of natural

habitats; avoids the significant conversion

or degradation of critical natural habitats,

and if avoiding the significant conversion of

natural habitats is not technically feasible,

includes measures to mitigate or offset

impacts or program activities.

Not relevant. Not relevant. Same as above.

Takes into account potential adverse

impacts on physical cultural property and,

as warranted, provides adequate measures to

avoid, minimize, or mitigate such effects.

Not relevant. Permenkes 75/2014 Appendix 1 - about

Puskesmas location.

The construction of Puskesmas facility

often involved local community leaders

and “gotong royong” system (in-kind, or

working together) so that necessary

information related to physical cultural

resources is always taken into account.


Policy Element c) Program systems protect public and worker safety against the potential risks associated with: (i) construction and/or

operations of facilities or other operational practices under the PforR Program; (ii) exposure to toxic chemicals, hazardous waste, and

other dangerous materials under the PforR Program; and (iii) reconstruction or rehabilitation of infrastructure located in areas prone to

natural hazards.

Key Attributes Related to Policy

Element Relevance to Program Provisions in System Practice

Promotes community, individual, and

worker safety through the safe design,

construction, operation, and maintenance of

physical infrastructure, or in carrying out

activities that may be dependent on such

infrastructure with safety measures,

inspections, or remedial works

incorporated as needed.

Relevant. Accreditation system for Puskesmas and

private clinics under I-Sphere program

(including standards related to worker and

patient safety and public health during the

operations of the HCF and its waste

management handling).

In general, the promotion of health and

safety in HCF operations is meeting the

standard for some areas in western part

of Indonesia (Sumatera, Bali, Jawa) but

need attention for eastern part of

Indonesia.

Promotes the use of recognized good

practice in the production, management,

storage, transport, and disposal of

hazardous materials generated through

Program construction or operations; and

promotes the use of integrated pest

management practices to manage or reduce

pests or disease vectors; and provides

training for workers involved in the

production, procurement, storage,

transport, use, and disposal of hazardous

biological waste in accordance with GIIP.

Relevant

Law No. 32/2009 on The Protection and

Environmental Management, requires

management of materials and waste that

are classified as dangerous and/or

poisonous or B3 (Bahan Berbahaya dan

Beracun)

Government Regulation No. 74/2001 on

Management of Hazardous Materials),

Government Regulation No. 101/2014 on

Management of Toxic and Hazardous

Waste, Government Regulation

No.27/2012 on Environmental Permit).

MOEF Decree no 56/2015 on Procedures

and Technical Requirement of Hazardous

Waste Management from Health Care

Facilities or FASYANKES and

Kepbappedal No 03/Bapedal/09/1995 on

Emission standards from Incinerators.

For the national laws and regulations: No

significant gaps with regards to policy

and law and regulations. As part of

Puskesmas Accreditation requirements,

HCFs are required to develop Standard

Operating Procedures (SOPs) or Work

Instructions in the handling of both

medical solid and liquid waste and also

expired chemicals/reagents/medicines

and radioactive waste. The requirements

in MOEF Decree no 56/2015 are

equivalent to the WBG EHS Guidelines

for Healthcare Facilities as they cover

GIIP such as labelling and symbols for

hazardous materials and waste, waste

reduction, segregation, storage,

transportation (manifest), treatment and

handling (with autoclave, incineration),

health workers’ occupational health and

safety and public health and safety. From

the field visit to Riau, Java, Bali from





natural hazards.



Medical Solid Wastes:

As regulated in the MOEF Decree No

56/2015 above and MOH Decree No

1204/Menkes/SK/X/2004 on Provision of

Hospital Environmental Sanitation.

PP 101/2014 and MOH Decree no

1204/Menkes/SK/X/2004 on Provision of

Hospital Environmental Sanitation

specifies incinerator requirements and

outlines requirements for safe-handling of

hazardous waste materials.

MOH Decree no

1204/Menkes/SK/X/2004 provides

specific treatment for each type of

medical wastes.

Medical Liquid Wastes

The MOH Decree no

1204/Menkes/SK/X/2004 (aligned with

WHO’s guidelines) require HCFs to apply

the following measures in the handling of

medical liquid wastes.

MoE Decree No 58/1995 on Hospital

Effluent Discharge Standard includes pH,

BOD, COD, Temperature, NH3, PO4,

Microbiology (e-Coli) and Radioactive

(11 elements, 12 isotopes).

other projects related to health care

system (DAK, RIDF), permit documents

are found in the field also all necessary

equipment for waste handling such as

dedicated bins for sharps, infectious

waste and all personnel wear PPEs.

However, this is not be the case for

Eastern part of Indonesia as the capacity

and the comprehension of the staff at

HCF and government agencies are still

low. A specific intervention might be

needed for this region under the I-Sphere

program.

Management System (HWMS).

No significant gaps between the policy

and procedures for handling the

wastewater. The GOI system has also the

effluent standard that specifically

regulate hospital’s effluent similar and to

the WBG EHS Guidelines for Health

Care Facilities (Performance

Monitoring), even for specific parameter

it is stricter, for example 100 mg/L for

COD (Indonesia) and 250 mg/L (WBG

Guidelines). The main challenge now is

to strengthen the accreditation system by

developing a standardized work

instruction or SOP on how to evaluate





natural hazards.



MOH Regulation No 37/2012 about

Laboratory Management for

PUSKESMAS covers provisions about

liquid and hazardous waste from hospital

laboratory.

I Sphere program.

the performance of the treatment system

for wastewater and understanding the

mechanism for identification and

troubleshooting of the abnormal

condition (excedance, equipment

malfunction etc.).

Includes measures to avoid, minimize, or

mitigate community, individual, and

worker risks when Program activities are

located within areas prone to natural

hazards such as floods, hurricanes,

earthquakes, or other severe weather or

climate events.

Relevant Permenkes 75/2015- Appendix 1-

regulates the requirement of the location

of the Puskesmas that must be free from

natural hazards such as hurricanes, floods,

earthquake (faults), steep slope, tsunami,

at river bank area (erosion potential) etc.

Also the provision of the community

participation approach as required in the

Puskesmas accreditation system (under I-

Sphere program).

No significant gaps between regulation

and implementation as the construction

of Puskesmas facility often involved

local community leaders and “gotong

royong” system (in-kind, or working

together) so that necessary information

related to natural hazards is always taken

into account.


Policy Element d) Program systems manage land acquisition and loss of access to natural resources in a way that avoids or minimizes

displacement, and assist the affected people in improving, or at the minimum restoring, their livelihoods and living standards.



Avoids or minimizes land acquisition and

related adverse impacts;

Not relevant. Not relevant. Not relevant.

Identifies and addresses economic and

social impacts caused by land acquisition

or loss of access to natural resources,

including those affecting people who may

lack full legal rights to assets or resources

they use or occupy;


Provides compensation sufficient to

purchase replacement assets of equivalent

value and to meet any necessary

transitional expenses, paid prior to taking

of land or restricting access;


Provides supplemental livelihood

improvement or restoration measures if

taking of land causes loss of income-

generating opportunity (e.g., loss of crop

production or employment);


Restores or replaces public infrastructure

and community services that may be

adversely affected.



Policy Element e) Program systems give due consideration to the cultural appropriateness of, and equitable access to, PforR Program

benefits, giving special attention to the rights and interests of the Indigenous Peoples and to the needs or concerns of vulnerable groups.



Undertakes free, prior, and informed

consultations if Indigenous Peoples are

potentially affected (positively or

negatively) to determine whether there is

broad community support for the program.

Interventions to be

undertaken in priority

districts that will

potentially benefit

Indigenous Peoples.

Community level systems exist to enable

participation.

HDW and Social Mapping.

HDW is new and social mapping has

been tested and the practice is varied.

Ensures that Indigenous Peoples can

participate in devising opportunities to

benefit from exploitation of customary

resources or indigenous knowledge, the

latter (indigenous knowledge) to include

the consent of the Indigenous Peoples.


Gives attention to groups vulnerable to

hardship or disadvantage, including as

relevant the poor, the disabled, women and

children, the elderly, or marginalized ethnic

groups. If necessary, special measures are

taken to promote equitable access to

program benefits.

The program is focused on

the 100 priority districts of

high stunting prevalence

and incidence.

So specific systems exist except for

village level systems.

Vulnerable groups identified based on

literature review and fieldwork. Practice

on inclusive approaches still under

assessment.


Policy Element f) Program systems avoid exacerbating social conflict, especially in fragile states, post-conflict areas, or areas subject to

territorial disputes.



Considers conflict risks, including

distributional equity and cultural

sensitivities.

Program involves

distribution of

supplements including

nutritional supplements.

Potential for elite capture.

Real or perceived

differences in how

benefits of program are

distributed may lead to

potential conflict.

Human Development Workers

Social Mapping.

HDW is new and social mapping has

been tested and the practice is varied.


Annex 5: Capacity Assessment in Managing Environmental Related Issues and Risks for INEY-PforR

Environmental Issues and

Risks

Capacity Assessment in Managing Environmental Issues and Risks

Policies, Regulations, Guidelines Institutional

Arrangement

Budget for Improved

Capacities

Monitoring & Supervision

(Support Needed for the

Implementation)

(1) (2) (3) (4)

Priority Service #1: Maternal and Child Health Services

Supply, distribution, and

storage of

vitamins/supplements.

Particular issues on disposal of

expired vitamins, and storage

of oversupplied vitamins.

The Ministry of Health Guidelines

(2016) regarding: The Integrated

Management for Vitamin A

Supplement.

Provisions: Planning, supply,

storage and distribution of Vitamin

A.

(a). Planning: Number of supplies

is calculated and prepared based on

data derived from the district health

offices of the MOH. This process

aims to avoid either under-supply

or over-supply of vitamins. Data for

targeted beneficiaries were taken

from the Health Development

Program (Program Pembangunan

Kesehatan)

(b) Supply: Vitamins are supplied

by Directorate General of Public

Pharmaceutical and Health Supplies

(Direktorat Tata Kelola Obat

Publik dan Perbekalan Kesehatan)

through pharmaceutical facility at

the district level. At the same time,

buffer stocks are kept at the

National: Ministry of

Health, including:

- Directorate of

Primary Care

- Directorate General

of Community Health


of Public

Pharmaceutical and

Health Supplies

Province/District:

District Health

Offices,

Pharmaceutical

Facility at the

provincial and district

levels.

Sub-district:

Puskesmas staffs

Village: Posyandu

cadres

Questions to ask:

National level:

- To implement the provisions

stated in the column (1), are

the

systems/operational/running

cost etc funded from APBN or

APBD or other sources?

- How much or what is the

percentage of the overall

health funding: national (if it is

funded by APBN) and/or

district level (if APBD) is used

to implement the provisions

stated in column (1)?

Provincial/District levels:

- How they feel/think about the

quality of

supervision/monitoring from

the central government?

- What would be the best

approach to improve/build

capacities (i.e. their

Questions to ask:

National Level:

- What are their experience(s)

in implementing these

provisions?

- What are the main

constraints in getting the

system working in accordance

to the Guidelines?

- Who monitor/supervise the

implementation?

- Since the Guidelines does

not provide tools to manage

the rare case of over-supply,

what is the government

provision on such a cases? Is

this regulated?

Provincial/District levels:

Are they aware of this

Guidelines?

- If so, what are the main

constraints in getting the


provincial level of the

pharmaceutical facility.

(c) Storage and Distribution:

Vitamins are kept safely at the

pharmaceutical facility according to

procedure regulated by the MOH.

Distribution is handled by

pharmaceutical facility at the

district level to Posyandu through

Puskesmas.

suggestions on improved

capacities)

Village level (Posyandu):

Have they been trained

regarding the implementation

of the Guidelines? Particularly

on procedure to apply when

vitamins are oversupplied?

system working in accordance

to the Guidelines.

- If not, what mechanism (of

planning, supply, storage and

distribution) that they

currently use?

Village level (Posyandu):

- Have they been trained

regarding the implementation

of the Guidelines?

- What procedures to apply

when vitamins are

oversupplied?

- Who came to visit their

health post/center

(Posyandu)? How many times

a year?

- What are the main messages

they got during the visit?

- How they feel/think about

the quality of

supervision/monitoring?

- What would be the best

approach to improve/build

capacities (i.e. their

suggestions on improved

capacities)


Supply, distribution, and

storage of vaccines, and

disposal of Pharmaceutical

waste

(expired/damaged/unused

vaccines, vaccine vials, used

syringes)

Ministry of Health Regulation No.

12 Year 2017 on The

Implementation of Immunizations.

Provisions: Planning, supply and

distribution, storage and

maintenance, waste disposal, and

monitoring & evaluation.

(a) Planning: The central

government in collaboration with

the local governments conduct

regular planning on the

implementation of immunizations.

Local governments are responsible

for the operational of the

immunization including the

maintenance of cold chain

equipment. Number of supplies is

calculated and prepared based on

local government’s annual proposal

(to the central government) on

target beneficiaries.

(b) Supply: The central

government is responsible for the

supplies; include Vaccines, ADS

(Auto Disable Syringe), Safety

Box, Anaphylactic equipment, Cold

Chain equipment, and Record-

keeping of immunization services.

In regards to Cold Chain

equipment, it includes storage (cold

room, freezer room, vaccine

refrigerator, freezer), vaccine

transportation (cold box, vaccine

carrier, cool pack), and supporting

equipment (thermometer, alarm,

National: Ministry of

Health, including:

- Directorate of

Primary Care


of Community Health


of Public

Pharmaceutical and

Health Supplies

Province/District:

District Health

Offices,

Pharmaceutical

Facility at the


levels.

Sub-district:

Puskesmas staffs

Village: Posyandu

cadres

Questions to ask:

National level:

- Since the immunization

program is conducted regularly

by qualified/trained staffs,

what is the percentage of

training budget from the

overall total budget of national

immunization program?

- What is the source of

funding:

APBN/APBD/Others?

District and village level:

Have they been trained on this

particular provision? How

many times? When is the last

time?

Questions to ask:

National Level:

- What are their experience(s)

in implementing this

provision?

- Who (or which directorate)

is responsible to

monitor/supervise the overall

quality of the implementation?

- Who (which institution

exactly) is responsible to

provide storage and

transportation for vaccines at

provincial and district level?

And who monitors the safety

of equipment for vaccine

storage and transportation)

- The Regulation suggests that

disposal of pharmaceutical

waste are the responsibility of

Puskesmas. In this case,

which Directorate at MOH

monitors and supervises the

quality control?

District and village level:

- How they feel/think about

the quality of safety in

handling, distribution, storage

and transportation of the

vaccines?


etc.). Supplies of vaccines are

managed by BUMN, appointed by

the Health Minister.

(c) Distribution: Central

Government distributes Vaccine,

ADS and Safety Box to Puskesmas

through the provincial and district

governments, whereas Cold Chain

is delivered directly to the targeted

locations. Other logistics distributed

directly by the Provincial and

District Governments.

(c) Storage and Maintenance:

Governments at the provincial and

district levels are responsible for

the storage and maintenance of the

equipment and logistic of

immunization program, as well as

provisions for trained/qualified

human resources to manage and

implement the program.

(d) Waste Disposal: For

immunization conducted in

Posyandu, staffs who conduct the

immunization are responsible to

collect the ADS waste (vial and/or

vaccine vial) into the Safety Box.

The Safety Box is then delivered to

Puskesmas to handle and dispose

the waste.

[Note: Puskesmas will be the key

actor in pharmaceutical waste

- With their experiences in

this provision, what would be

the best approach to improve

the implementation of safety

measures for the equipment.

- Were they involved in the

safe-handling procedure? If

so, did they get any training

for that?


disposal. Assessment on their

capacity is crucial]

(e) Monitoring and Evaluation:

Central government, provincial and

district governments are responsible

for M&E.

[Note: Although the instruments are

well-planned, M&E on the

implementation of waste

management and disposal at

Puskesmas is not included].

Ministry of Environment and

Forestry (MoEF) Decree No. 56

Year 2015 on Procedures and

Technical Requirements of

Hazardous Waste Management

from Health Care Facility.

Provision: As part of Puskesmas

Accreditation requirements, Health

Care Facilities (HCFs) are required

to develop Standard Operating

Procedures (SOPs) in the handling

of medical waste (solid and liquid)

and pharmaceutical waste.

Permitting System. District

environmental agency issues a

permit for solid hazardous waste

handling (burial technique).

For transportation, handling and

disposal is from MoEF Jakarta.

National: MoEF

Province/District:

District Health

Offices,

Pharmaceutical

Facility at the


levels.

Sub-district:

Puskesmas staffs

Questions to ask:

National Level:

- The standard is regulated by

MoEF and implemented by

MOH. In this case, has MOH

provided budget to support the

provision of handling and

disposal of medical and

pharmaceutical waste?

- Assuming that the national

level does not provide funding

for the implementation of

MoEF’s standard, how does

the central government ensure

the waste disposal is properly

handled?

Questions to ask:

National Level:

Since the provision is

regulated by the MoEF, what

is the level of coordination

between MOH and MoEFF

(i.e. do they meet regularly

discussing the quality control

and compliance?)

District/Village Level:

Puskesmas’ SOPs for

handling medical and

pharmaceutical waste:

- Can we have a copy of it?

- Do they have the

facility/equipment to

implement the SOP?

- Any SOP related to patient

safety, public health safety

and worker’s health and

safety.


Bupati can only issue permit for

temporary hazardous waste storage

at district level (if Puskemas has

one)

- Within the boundary of

Puskesmas institution, who is

responsible for the handling

and disposal of these waste?

Trained/qualified?

- What are the struggles in the

implementation?

- What is the suggestion for

improved implementation?

-Any permit required for

storage, handling, transporting

or disposal of hazardous

waste?

Ministry of Health Regulation No.

2 Year 2017 on the Guidelines for

Prevention and Control of Infection

in Health Care Facility.

Provisions: Safe handling and

disposal of used syringes, including

the method of waste disposal (use

of incinerator)

National: MOH

District/Village:

Puskesmas

Questions to ask:

District/Village (Puskesmas):

- What is their experience in

handling the used syringes?

Did they get training for this

purpose?

- Do they know the location of

the incinerator where they

send the used syringes?

Priority Service #3: Water and Sanitation

Access to improved drinking

water: water testing/sampling,

safe distance from water

pollution sources, water

collection and distribution

Technical guidelines for the

construction of community level

water supply facility (developed

through PAMSIMAS and PNPM

Rural)

MOH guidelines on parameters for

water quality

National: MPWH and

MOH

District: District level

SKPD

Village: village

governments,

BUMDes, BPSAM,

community members

Questions to ask:

National Level:

- Availability and access to

budget for training on the

installation of water supply?

District/Village Level:

Questions to ask:

National Level:

- Which institution conducts

regular monitoring and

supervision for the quality of

drinking water installation?

- Which institution is

responsible for watershed

protection?


Operational/running costs for

monthly fee (iuran) and spare

parts

Village

Level/KSM/BPPSPAM:

Water quality testing, number

of membership, sustainability

of the sources

Access to improved sanitation

facility: safe distance,

construction quality

(engineering design),

provisions of water supply to

toilets.

Technical guidelines for the

construction of community level

water supply facility (developed

through PAMSIMAS and PNPM

Rural)

National: MPWH and

MOH

District: District level

SKPD

Village: village

governments,

BUMDes, BPSAM,

community members

Questions to ask:

National Level:

- Availability and access to

budget for training on

construction of sanitation

facility?

Questions to ask:

National Level:

- Which institution conducts

regular monitoring and

supervision for the quality of

sanitation facility?

Village

Level/KSM/BPPSPAM:

ODF Free, distance of septic

tanks from water source (> 10

m).

Priority Service #5: ECED

Hand washing program National curriculum on the

provision of hand-washing program

National: MOEC

District: District

education agencies,

GSC facilitators,

PAUD cadres,

community member

N/A

Questions to ask:

National Level:

Does the ministry have the

provision of such a

curriculum?


Annex 6: Social considerations of nutrition-specific and nutrition-sensitive interventions.

Interventions Activities Activities with Social

Risk Potential

Level of

Concern

Systems and Capacity to be

Reviewed

Nutrition Specific -

Iron folic acid

supplementation

- IFA Data Verification & Forecasting

- IFA Procurement, Storage (buffer stock only) and

Distribution (buffer stock only)

- IFA Verification, Collection, Storage and

Distribution

- Anemia hemoglobin test

- Dispensing of IFA supplements

- Posyandu outreach

- Anemia hemoglobin

test

- Dispensing of IFA

supplements

- Posyandu outreach

Low Delivery to understand approach to

different beneficiary groups.

Inclusiveness, Consent, Complaints,

Accessibility, Context Specific.

Vitamin A

Supplementation

- Vitamin A Procurement, Storage and Distribution

- Vitamin A Forecasting

- Vitamin A campaigns (including integrated

campaigns with immunization, deworming)

- Dispensing of Vitamin A supplements

- School coordination activities

- Outreach/Sweeping activities

- Posyandu, PAUD coordination activities

- Vitamin A

campaigns (including

integrated campaigns

with immunization,

deworming)

- Dispensing of

Vitamin A

supplements

- Outreach/Sweeping

activities





Basic Immunization - Data Verification and Forecasting

- Vaccines Forecasting, Procurement and Distribution

- Auto Disable Syringe (ADS) Procurement and

Distribution

- Safety Box Procurement and Distribution

- Cold Chain Storage Procurement and Distribution

- Temperature Monitoring Device Procurement and

Distribution

- Vaccine Transportation Equipment and Temperature

Monitoring Device Procurement and Maintenance

- Auxiliary Cold Chain Equipment Procurement and

Maintenance

- Vaccine and Equipment Storage

- Vaccine

Administration

- Outreach Activities

- Coverage

Improvement

Activities

- Outbreak Response

Immunization







Risk Potential

Level of

Concern


Reviewed

- Vaccine, ADS, Safety Box, Anaphylatic Devices

Distribution

- Medical Waste Management

- Vaccine Collection and Distribution

- Immunization Operational Costs at Facilities

(Puskesmas, Posyandu, School)

- Vaccine Collection and Distribution

- Vaccine Administration


- Coverage Improvement Activities

- Outbreak Response Immunization

Micronutrient

Powder

Supplementation

(Taburia) (Pilot

ONLY)

- Taburia Forecasting

- Taburia Procurement, Storage and Distribution

- Taburia Storage

- Taburia Distribution


- Taburia Distribution






Deworming - Deworming Medicine Forecasting, Procurement,

Storage and Distribution

- Laboratory Test Supplies and Equipment

Procurement

- Laboratory Testing for Worms

- Mass Deworming Medicine Administration

- Mass Deworming Campaign at Schools

- Mass Deworming Campaign at Posyandu

- Mass Deworming

Campaigns





Growth Monitoring

and Promotion

- Production of Buku KIA, KMS

- Procurement for Dacin

- Ensuring adequate GMP content in the national pre-

and in-service training for healthcare providers

- Conduct GM surveillance

- Procurement of PWS Gizi Form, Posyandu Kit and

Balok SKDN

- Conduct supervision for POKJANAL Posyandu

team

- GMP TOT training for midwifes/nutritionist and

cadres

- Growth Monitoring

and Promotion

- Home Visit

- Outreach and

sweeping







Risk Potential

Level of

Concern


Reviewed

- Conduct supportive supervision for Puskesmas to

implement GMP practice

- Create Puskesmas POA for GMP

- Refresh the cadre in GMP practice

- Production of IEC materials

- Recording and reporting

- Cross-program coordination for GMP at Puskesmas

level

- Multisectorial coordination for GMP at sub-district

level

- Consult Puskesmas GMP practice to district level

- Conduct supportive supervision for Posyandu to

implement GMP practice

- Growth Monitoring and Promotion

- Home Visit

- Outreach and sweeping

Infant and Young

Child Feeding:

- Multisectorial coordination for nutrition intervention

and 1000 HPK at national level

- IYCF counselling course for master trainers

- Ensuring adequate IYCF content in the national pre-

and in-service training for healthcare providers

- Institutionalization of Baby Friendly Hospital

Initiative and Hospital’s baby Friendly accreditation

- Improve complementary feeding and diets for

children aged 6-23 months

- Procurement of supplementary feeding (Makanan

Tambahan Penyuluhan dan Pemulihan) for pregnant

women (MT Ibu Hamil), children under five (MT

Balita) Provinces and elementary school students

(MT Anak Sekolah)

- Procurement of supplementary feeding for

elementary school students (MT Anak Sekolah) –

buffer stock only

- Conduct nutrition surveillance

- Production of pedoman Gizi

- Dispensing MT to

the

district/Puskesmas

level

- Distribute pedoman

gizi to district level

- Behaviour change

communication

training for

Puskesmas and

cadres

- Dispensing MT

Anak Sekolah to

Puskesmas level

- Production of IEC

materials Dispense

MT to

Posyandu/other







Risk Potential

Level of

Concern


Reviewed

- Conduct supportive supervision for Provincial and

District to implement IYCF practice

- Dispensing MT to the district/Puskesmas level

- Distribute pedoman gizi to district level

- Behaviour change communication training for

Puskesmas and cadres

- Procurement of supplementary feeding for

elementary school students (MT Anak Sekolah)

- Dispensing MT Anak Sekolah to Puskesmas level

- IYCF TOT training for midwifes/nutritionist and

cadres

- Conduct supportive supervision for Puskesmas to

implement IYCF practice

- Create Puskesmas POA for IYCF

- Cross-program coordination for IYCF at Puskesmas

level

- Multisectorial coordination for IYCF at sub-district

level

- Procurement of MP-ASI Lokal

- Refresh the cadre in IYCF practice

- Production of IEC materials

- Recording and reporting

- Dispense MT to Posyandu/other Puskesmas

networks, e.g. PAUD, school

- Appointment of health promotion contract workers at

Puskesmas for IYCF

- Conduct supportive supervision for Posyandu to

implement IYCF practice

- Dispense MT Pemulihan for target beneficiaries

- Produce local source MT Penyuluhan

- Provision of local commodities and sustainable

foodstuffs

Puskesmas networks,

e.g. PAUD, school

- Dispense MT

Pemulihan for target

beneficiaries

- Produce local source

MT Penyuluhan

- Provision of local

commodities and

sustainable

foodstuffs

Antenatal and

Postnatal Care

- IFA Data Verification & Forecasting

- IFA Procurement, Storage (buffer stock only) and

Distribution (buffer stock only)

- Dispensing of IFA,

Vitamin A

supplements

Low Village and Household Level

Delivery to understand approach to




Risk Potential

Level of

Concern


Reviewed

- Vitamin A Procurement, Storage and Distribution

- Integrated Family Health Services Training

- Ensuring adequate Integrated Health Services for

Mother and Child content in the national pre- and in-

service training for healthcare providers

- Procurement for KB logistics

- Procurement for IEC materials (KIE Kit

Kependudukan KB dan Pembangunan

Keluarga/KKBPK)

- Orientation for Kelas Ibu Facilitators

- Create Puskesmas POA for integrated family health

services

- Cross-program coordination for integrated family

health services at Puskesmas level

- Multisectorial coordination for integrated family

health services at sub-district level

- Refresh the cadre on integrated family health

services

- Anemia hemoglobin test

- Dispensing of IFA, Vitamin A supplements

- Vitamin A campaigns (including integrated

campaigns with immunization, deworming)

- School coordination activities


- ANC/PNC visits

- Establish Midwife-Traditional Birth Attendance

Partnership Program

- Conduct supportive supervision for Polindes

- Posyandu outreach

- Posyandu, PAUD coordination activities


- Conduct Kelas Ibu

- Vitamin A

campaigns (including

integrated campaigns

with immunization,

deworming)

- ANC/PNC visits

- Establish Midwife-

Traditional Birth

Attendance

Partnership Program

- Posyandu outreach

- Outreach/Sweeping

activities

- Conduct Kelas Ibu



Nutrition Sensitive - -

Access to Clean

Water

- Program dissemination and advocacy workshop to

district leaders

- PAMSIMAS Grant

for Facilities

Low The construction aspects will be

undertaken under PAMSIMAS so



Risk Potential

Level of

Concern


Reviewed

- Support to local gov’t on WASH strategy

development and evaluation

- Provision and capacity building of community

facilitators

- Capacity building of village-leaders

- Capacity Building for BPPSPAMs and its

Association

- Capacity building of BPMD for mentoring

BPPSPAMs

- PAMSIMAS Grant for Facilities Construction and

community empowerment activities

- Technical and Management Consultants Recruitment

- Village selection and updating target beneficiaries

- WSS Facilities construction to expand service,

including school sanitation and public facilities

- Capacity building of CBOs/BPPSPAMs

- Matching fund (10% of project budget)

- Grant to BPPSPAMs to expand service

Construction and

community

empowerment

activities

- WSS Facilities

construction to

expand service,

including school

sanitation and public

facilities

represents no risk for the INEY

Program.

Access to Sanitation - Knowledge management and benchmarking among

districts & provinces on STBM progress

- STBM network and partnership development

- Capacity building for DHO through workshops and

coordination meeting

- Capacity Building on STBM-Stunting and

multisectoral intervention context

- Provincial Coordinators Recruitment

- Capacity building and coordination meeting with

sanitarian

- STBM activities for community level

- Upgrading infrastructure support to sustain ODF

villages

- District Facilitator Recruitment

- Acceleration access in targeted beneficiaries

- Upgrading

infrastructure support

to sustain ODF

villages

- Acceleration access

in targeted

beneficiaries

Low The Upgrading infrastructure

support to sustain ODF villages will

be done under PAMSIMAS so

represents no risk for the INEY

Program.

Provision of

universal, high-

- ToT and Capacity Building (for District Trainers and

NGO Training Organizers)

- Education activities Low Delivery to understand approach to




Risk Potential

Level of

Concern


Reviewed

quality ECED

services (for

children ages 3-6)

- ToT and Capacity Building (for district ECED

Supervisors)

- Accreditation of ECED facilities

- Training of ECED teachers & personnel

- Supervision of ECED teachers and facilities

- Education activities

Inclusiveness, Accessibility, Context

Specific.

Parenting education

on early stimulation

and nutrition (for

children ages 0-2)

- ToT and Capacity Building (for district government

officials)

- Training of village cadres (and other village

stakeholders)

- Education activities

- Education activities Low Delivery to understand approach to


Inclusiveness, Accessibility, Context

Specific.